| Summary: | 碩士 === 高雄醫學大學 === 醫務管理學研究所碩士在職專班 === 97 === Research Purposes
In recent years, with the development and progress of medical
technology, there are more and more advanced medical instruments and
equipment available, allowing many patients with respiratory failure to
survive. Moreover, with population ageing and the prevalence of chronic
diseases, the number of long-term ventilator-dependent patients has
gradually increased. Clinically, among patients who use ventilators to
maintain their life, around 20-25% of them cannot immediately wean
from the ventilator after their potential problems have been solved. And
among patients with long-term use of ventilators, some individuals even
cannot wean from the ventilator and eventually become
ventilator-dependent patients.
The purposes of this study are to understand the influencing factors
of ventilator weaning in ventilator-dependent patients, investigate the
utilization of medical resources and its relevant influencing factors for
these patients, and track to the survival rate of these patients within a year
after hospital discharge by collecting retrospective data and statistics. It is
hoped that this study can help construct evaluation indices for the health
care of ventilator-dependent patients and provide health care facilities
with references for planning the health care of patients, offering more
training to patients of higher weaning success rate, and transferring
patients of lower weaning success rate to respiratory care wards or
sending they home for receiving ventilation at home to effectively reduce
the cost of medical resources and achieve better medical effects.
Research methods
This study is a retrospective study and the research subjects were
mainly the patients hospitalized in the respiratory care center in certain
medical center in southern Taiwan from January, 2006 to December,
2007. A total of 284 patients were enrolled in this study. Statistical
methods such as multiple linear regression analysis, multiple logistic
regression analysis, and Cox proportion hazards analysis were used to
investigate the influences of demographic profiles of patients, main
reasons for using ventilators, relevant indices of ventilator weaning,
disease severity, the presence of complications, using ventilators again
due to weaning failure, the days of reusing ventilators, and relevant blood
biochemical values on the ventilator weaning, mortality, medical
expenditure, and the inpatient days of ventilator-dependent patients.
VI
Research results
The research results indicated that the average age of patients was
72±15 years and the number of male patients was 152 (53.5%), which
was more than female ones; most of the patients (57.4%) were transferred
from the internal intensive care unit; the main reason for using ventilators
was mostly (27.5%) congestive heart failure (CHF); the average disease
severity of patients (APACHE II) was 16.84±4.23; the average Charlson
Comorbidity Index (CCI) was 1.95±1.61; 31.3% patients had received
tracheostomy; the mortality of patients after hospital discharge within a
year was 55.63%.
The multiple linear regression model indicated that patients with
weaning failure and using ventilator again had a higher possibility to
become ventilator-dependent patients (P<0.001); among the relevant
influencing factors for medical expenditure, the most influential factor
was using ventilator again due to weaning failure, followed by receiving
tracheostomy (P<0.001).
The Cox regression analysis was used to investigate the main
influencing factors relevant to the survival rate of patients after hospital
discharge within a year. The results indicated that gender, presence of
cardiac complications, the value of blood urea nitrogen, APACHE II, and
using ventilator due to congestive heart failure were all important factors
that influenced the mortality of patients.
The results of linear regression analysis for analyzing the relevant
factors of inpatient days indicated that receiving tracheostomy, Charlson
Comorbidity Index (CCI), using ventilators again due to weaning failure,
and the days of reusing ventilators were all important factors which
influenced the inpatient days of patients. Among the influencing factors
of inpatient days, the most influential one was the days of reusing
ventilators, followed by using ventilators again due to weaning failure.
Conclusions and suggestions
The study showed that the receiving tracheostomy, using ventilators
again due to weaning failure, Charlson Comorbidity Index, and the days
of reusing ventilators were the most influential variables for determining
whether ventilator-dependent patients could successfully wean from
ventilators and reduce the cost of medical resources. Therefore, to reduce
the mortality of patients, increase the weaning success rate, decrease
inpatient days, and reduce the cost of medical resources, it is suggested
VII
that when preparing for weaning ventilator-dependent patients from
ventilators, it is necessary to provide patients with enough relevant
training and the weaning shall be conducted after patients’ condition is
steadily controlled.
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