2018-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/656709摘要：由於人口老化及慢性共病症的增加，使得呼吸器的使用也跟著增加。呼吸器雖然可以幫助病人在罹患重症時存活下來，但廣泛及無限制的呼吸器使用，伴隨創造出一群嚴重失能且長期依賴重症照護的病人。對於這群情況特殊的病人，目前文獻多以慢性重症疾患(Chronic critical illness)一詞來描述之，研究資料顯示，美國每年需投入大量的醫療資源，來醫治這群慢性重症疾患的病人，且這樣的花費正在逐年上升中。台灣的情況可能比美國更為沉重，台灣每年有超過17萬人次的呼吸器使用，而這當中有2萬5千人會成為長期呼吸器(Prolonged mechanical ventilation)的患者，這樣的比率明顯高於其他國家。若欲避免對重症患者施予過度的侵入式醫療，病人的預後資料將是很重要的醫療決策參考依據，但目前的呼吸器預後資料多著眼於死亡率，而死亡率的資料對病人及其家屬在決定是否延續其重症治療時，幫助有限。相較之下，病人日後的身體功能狀態及生活品質，更是影響病人與家屬決定的重要因素，而身體功能狀態又比生活品質更為客觀及易於測量。在這個2年期的研究計畫中，我們會評估病人呼吸衰竭前的身體功能狀態以及呼吸衰竭當次事件的嚴重度，並剖析這兩個面向的變數如何影響日後病人的失能狀態、醫療需求、呼吸器脫離率、及死亡率。<br> Abstract: The use of invasive mechanical ventilation is increasing worldwide due to an aging and increasingly sick population. Mechanical ventilation helps patients to survive acute critical illness; however, it also imposes a huge burden on the healthcare system by leaving a growing population of chronically debilitated patients requiring intensive care. The term “chronic critical illness” is widely used to describe this specific patient population. The data from the United States show that caring for patients with chronic critical illness requires a lot of healthcare resources and the expenses are increasing. The condition may be worse in Taiwan. There are more than 170,000 patients receiving mechanical ventilation every year in Taiwan and around 25,000 of them require prolonged mechanical ventilation. The incidence is evidently higher in Taiwan than in other countries. To prevent futile treatment for such patients, prognostic information is of paramount importance in clinical decision making. However, previous data regarding prognosis of patients with mechanical ventilation usually focus on mortality outcome and they are not that helpful in decision making about whether to continue intensive therapies for patients. Both functional status and quality-of-life have substantial influence on patients’ preference about continuation of intensive therapies, and functional status is a more objective and easily quantified measure than quality-of-life. In this project, we aim to evaluate the effects of premorbid functional status and severity of the acute insult on patient outcomes in terms of disability, healthcare use, weaning success and mortality.慢性重症疾患失能機械通氣體能狀態呼吸衰竭chronic critical illnessdisabilitymechanical ventilationperformance statusrespiratory failure