Assessment of Diaphragmatic-Pleural Mechanics and Oxygen Uptake in Chronic Critical Illness with Chronic Organ Dysfunction Syndrome: Severity Association and Prognostic Implication = 橫膈膜-肋膜力學與攝氧量在慢性重症合併慢性多重器官功能失常的嚴重度評估，相關性和預後研究

Chronic Critical Illness (CCI) is generally defined as the clinical status of ventilator dependence and organ dysfunction after 7-14 days of acute intensive care admission. About 10-20% of all patients admitted to the intensive care unit due to acute intensive care will become in the CCI status. In addition to remaining at the state of prolonged mechanical ventilation, these patients need enhanced training to successfully liberate from the ventilator. However, multiple organs are dysfunctional, and the inflammatory immune metabolism is still in a state of dysfunction, which leads to the often unstable condition, repeated infections and more organ failure, which makes the weaning process difficult. Despite patients with ARF after the causes of acute respiratory failure (pneumonia, sepsis, etc.) are controlled, not all patients are successfully detached from the respirator. About 20% of patients will be re-intubated with respiratory failure within 72 hours after the first extubation, and there are not a few patients who fail the self-breathing test. These groups will undergo tracheostomy and transferred to a respiratory care center for protocoled weaning training, through longer training and observation to determine whether you can successfully weaned or require long-term respirator dependence. Ultrasound diaphragmatic evaluation has been available for many years, and in previous studies it was possible to predict the success of ventilator weaning in patients with acute respiratory failure in the intensive care unit. In the past, this method was rarely applied to patients in respiratory care center setting. Therefore, it is hoped to use this test to establish a predictive module to reduce the failure rate of ventilator weaning in patients. The clinical phenotype of CCI includes several dimensions, including chronic multiple organ dysfunction (chronic MOF), such as respiratory dysfunction, neuroendocrine dysfunction, persistent inflammatory immune suppression and catabolism, immunosuppression and catabolism syndrome (PICS), ICU-acquired weakness (ICUAW), neurocognitive and psychiatric dysfunction, in addition to persistent lung failure. This study will evaluate the clinical phenotype of patients who meet the diagnostic criteria for CCI in RCC patients, and distribute the phenotype of CCI based on the oxygen uptake before and after training and the diaphragmatic ultrasound (Diaphragm US). Correlation analysis and prognosis connection with ventilator weaning process will be performed.