2020-08-012024-05-18https://scholars.lib.ntu.edu.tw/handle/123456789/709559慢性重症(Chronic Critical Illness, CCI)一般定義為急性重症入住加護病房後7-14天之後仍存在呼吸器依賴和器官功能不良的臨床狀態。在所有因為急性重症入住加護病房的病人中，約有10-20%會轉變為CCI狀態；這些病人除了仍維持呼吸器依賴的狀態，需要進行加強的訓練以期順利脫離呼吸器，病人也經常因為多個器官功能不良，以及發炎免疫代謝功能仍在失調狀態，而導致病情經常不穩定，反覆感染和器官更加衰竭，因而使得呼吸器脫離訓練過程無法順利進行。急性呼吸衰竭之病人在當急性呼吸衰竭之原因(肺炎，敗血症等)受控制後，並非所有病人都能成功從呼吸器脫離。約20%的病人會在第一次拔管後72小時內再度因呼吸衰竭插管，而無法通過自呼試驗的病人也不在少數，這些族群就會進行氣切並轉到呼吸照護中心進行漸進式的呼吸訓練，通過更長時間的訓練與觀察來判斷是否能成功脫離或需要長期呼吸器依賴。超音波橫膈膜的評估行之有年，在過去的研究中可以對加護病房中急性呼吸衰竭病人呼吸器脫離成功與否進行預測。過去此方法較少應用在呼吸照護中心病人上，因此希望藉由本試驗來建立預測之模組，減低未來病人呼吸器脫離之失敗率。CCI的臨床表現型包括幾個領域，都和慢性多重器官失能症候群(chronic organ dysfunction, chronic MOF)有關，例如呼吸功能不良，神經內分泌功能失常，持續性的發炎免疫抑制和分解代謝(Persistent inflammation, immunosuppression and catabolism syndrome, PICS)，加護病房獲得之後天性無力(ICU-acquired weakness, ICUAW)，神經認知和精神失常(neurocognitive and psychiatric dysfunction)等。本研究將針對RCC入住病人符合CCI診斷條件者，進行臨床表現型的評估，並且針對脫離訓練前後的攝氧量(Oxygen uptake)和橫膈膜超音波(Diaphragm US)來將CCI的表現型分佈和呼吸器脫離過程進行相關性分析和預後連結。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.