臺灣博碩士論文加值系統

目的
隨著現代醫療進步，加護病房提供對重症病患較好的照護，這些患者一年耗費約佔健保支出的3%。呼吸照護中心主要是提供延長使用呼吸器病患之加強照護。
本研究的目的在於希望藉由回溯性的資料整理與統計後，以瞭解影響呼吸器依賴病患呼吸器脫離、呼吸器脫離後再使用、下轉呼吸照護醫院之相關因子，探討此類病患醫療資源使用情形及其相關影響因素；每位病患至少有一年追蹤期，追蹤該次住院於出院後一年的照護情形。
方法
本研究為回溯性之研究，主要是針對南部某醫學中心，於2008年1月至2008年12月住進呼吸照護中心之病患為主要研究對象，共計283位。以多項式對數迴歸分析、二項式對數迴歸分析與複迴歸分析，探討研究期間病患的人口學特質、使用呼吸器的主要原因、疾病嚴重度及臨床報告，包括過去研究認為可作為預測呼吸器脫離的預測變項，對呼吸器依賴病患RCC照護結果、照護品質和當次住院之醫療費用與住院天數的影響。
結果
研究結果顯示，研究期間病患平均年齡為72±13歲，男性病患164位（58%）多於女性，以內科加護病房所轉入的病患居多（66.1%）；使用呼吸器的主要原因重大病患最多（57.2%），病患疾病嚴重度（APACHE II）平均為16.9±6.4；有24.7% 的病患有作氣切，再次使用呼吸器平均天數18.5±6.4，當次住院出院後一年內的死亡率為59%。
進一步以多項式對數迴歸分析發現，RCC照護結果呼吸器依賴預測因子，在重置組呼吸衰竭（相對危險比：0.16）是其他組的6.13倍、Cr肌酐不正常（相對危險比：0.20）是正常的4.9倍、K鉀不正常（相對危險比：7.12）是正常的7.12倍；成功組呼吸衰竭（相對危險比：0.26）是其他組的3.87倍、Cr肌酐不正常（相對危險比：0.27）是正常的3.77倍、K鉀不正常（相對危險比：3.25）是正常的3.25倍。 另探討病患該次住院及出院後的一年內照護品質有關之主要影響因子，結果顯示氣切、呼吸器脫離中、電解質、氧療用具與介面皆是影響照護品質之重要因子。 而影響醫療資源相關因素中，結果顯示病患是否有氣切、電解質、APACHE II、超期留置因素與RCC照護結果之相互關係，皆是影響病患住院天數和資源耗用之重要因子。此研究結果將可作為呼吸照護中心未來醫療照護品質參考。
結論與建議
本研究證實病患其是否作氣切、是否再次使用呼吸器、APACHE II、超期留置因素、電解質平衡、氧療介面是減少住院天數及醫療資源耗用，最具影響力之變項；因此建議要為呼吸器依賴病患做呼吸器脫離之準備時，能給於足夠的相關訓練，且在疾病病程穩定控制後再進行，同時在拔管後可使用氧氣面罩或非侵入性呼吸器，可降低重插管率，提高病患脫離呼吸器的成功率，進而減少病患住院天數，降低其醫療資源之耗用。
也建議理想的呼吸照護病房之設立，對急性加護病房病床的利用與呼吸器病患的照護會有很大幫助，可提高醫療資源的運用。而醫學中心之RCC病患轉至地區之RCW，能夠縮短醫學中心的天數，使醫學中心之急性和RCC能有效率的運用床位，解決醫學中心長期呼吸器患者滯留現象和減少醫療成本之浪費。

Objectives
The intensive care units provide a good care quality for the critical ill patients in modern medicine. In Taiwan, they cost about 3% of the total medical insurance expense. Respiratory care center (RCC) provide effective care for patients.
The purposes of this study were to understand the factors related to ventilator weaning in patients with ventilator-dependence, the patients re-use the mechanical ventilation after weaning. And the patients are referred between the hospitals. This study is to investigate the utilization of medical resources and its relevant influencing factors for these patients, and track to the best results of these patients within a year after hospital discharge by collecting retrospective data and statistics.
Method
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, 2008 to December, 2008. A total of 283 patients were enrolled in this study. Statistical methods such as multinomial logistic regression, binary logistic regression, Multiple linear regression were used to investigate the influences of demographic profiles of patients, main reasons for using ventilators, APACHE II score, and clinical data, including variables identified previously as predictive of weaning success among highly selected populations, outcome analysis, quality of care, medical expenditure, and the inpatient days of ventilator-dependent patients.
Results
The research results indicated that the average age of patients was 72±13 years and the number of male patients was 164 (58%), which was more than female ones; most of the patients (66.1%) were transferred from the internal intensive care unit; the main reason for using ventilators was mostly (57.2%) severity illness included congestive heart failure (CHF); the average disease severity of patients (APACHE II) was 16.9±6.4; 24.7% patients had received tracheostomy; the average re-use the mechanical ventilation days after weaning 18.5±15.4, the mortality of patients after hospital discharge within a year was 59%.
In a multinomial logistic regression analysis, significant predictors of ventilator-dependent, the re-use of mechanical ventilation group included respiratory failure（0dds ratio〔OR〕0.16）、Cr un-normal lever（OR, 0.2）,K un-normal lever（OR,, 7.12）,at RCC admission. the patients successfully weaned group respiratory failure（OR 0.26）,Cr un-normal lever（OR, 0.27）,K un-normal lever（OR, 3.25）. Variables that were found to be significantly related to investigate the main influencing factors relevant to the survival, ventilator dependent or dead of patients after hospital discharge within a year. The results indicated that tracheostomy, long-term use of ventilators reasons, electrolyte, route on transfer were all important factors that influenced the medical care quality of patients. The relevant factors of inpatient days indicated that receiving tracheostomy, electrolyte, APACHE II, respiratory failure, multiple organ failure were all important factors which influenced the inpatient days and the utilization of medical resources of patients. The results could be helpful in the accreditation of medical care quality and may provide for future.
Conclusions and Suggestions
The study showed that the receiving tracheostomy, re-use ventilators, APACHE II, long-term use of ventilators reason , keeping electrolyte balance, route on transfer, significant predictors factors relevant to the decrease inpatient days, and reduce the cost of medical resources. It is suggested 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. The O2 face tent or Mask–BiPAP was applied after extubation, could be reduced the re-intubations rate.
The optimal function of respiratory care center could be maintained. The outcome of patients with long-term ventilator dependence in local hospital is as good as those in medical center. In addition, the total hospital days in medical center could be reduced, the bed utilization rate of medical ICU and RCC could be elevated, the ventilators and acute ward could save more acute-illness patients. Therefore, the limited health resources could be best utilized.

目 次
致 謝 I
摘 要 II
Abstract IV
目 次 VI
圖 次 VIII
表 次 IX

第一章 緒論 1
第一節 背景和動機 1
第二節 研究重要性 4
第三節 研究目的 5
第四節 預期貢獻 6
第五節 名詞解釋 7
第二章 文獻探討 9
第一節 長期使用呼吸器之相關概念 9
第二節 呼吸器依賴的概念及相關研究 15
第三節 呼吸器依賴病患醫療資源耗用之分析 19
第四節 全民健康保險呼吸器依賴病患照護前瞻性支付試辦計畫內容與試辦計畫成效之相關研究 21
第三章 材料與方法 28
第一節 概念架構與假設 28
第二節 研究設計和研究樣本 31
第三節 研究變項之定義 34
第四節 資料處理與統計分析 39
第四章 結果 41
第一節 研究樣本人口學特質描述性分析 41
第二節 RCC照護結果之推論性檢定 45
第三節 影響住院中照護品質呼吸器脫離或下轉的預測因子 50
第四節 探討影響出院後一年照護品質之預測因子 52
第五節 影響醫療費用、住院天數的分析 56
第五章 討論 61
第一節 呼吸器依賴病患在RCC照護結果的影響因子 61
第二節 呼吸器依賴病患照護品質之影響因子 65
第三節 呼吸器依賴病患之醫療資源耗用及其影響因子 68
第六章 結論和建議 70
第一節 結論 70
第二節 建議 72
第三節 研究限制及未來研究方向 74
參考文獻 75
中文部份 75
英文部份 78
附件一「全民健康保險呼吸器依賴患者整合性照護前瞻性支付方式」試辦計畫 83
附件二「全民健康保險呼吸器依賴患者整合性照護前瞻性支付方式」試辦計畫支付標準 89
附件三 IRB同意書 103

圖 次

圖 1-1 研究流程 …………………………………………………………………………8
圖 2-1 呼吸器依賴患者整合性照護流程圖 ………………………………………………26
圖 3-1 概念架構…………………………………………………………………………29


表 次
表2-1 呼吸照護整合系統試辦計劃照護各階段適用支付標準………………………25
表3-1 各變項之操作型定義 ………………………………………………………37~38
表4-1 人口學特質與病人屬性之分析 ……………………………………………43~44
表4-2 自變項與RCC照護結果組別依賴組、成功組、重置組之差異……… …46~47
表4-3 中介變項RCC照護結果組別與整合性照護品質、醫療資源耗用之差異 …48
表4-4 影響RCC照護結果組別的預測因子對比 ……………………………………49
表4-5 影響住院中照護品質脫離的預測因子對比……………………………………50
表4-6 影響住院中照護品質下轉的預測因子對比……………………………………51
表4-7 影響出院後一年照護品質成功的預測因子對比………………………………53
表4-8 影響出院後一年照護品質死亡的預測因子對比………………………………54
表4-9 影響出院後一年照護品質依賴的預測因子對比………………………………55
表4-10 影響病患當次住院總平均住院天數之預測因子………………………………57
表4-11 影響病患當次住院總平均住院費用之預測因子………………………………58
表4-12 影響當次平均RCC住院天數之預測因子 … …………………………………59
表4-13 影響當次平均RCC住院費用之預測因子 … …………………………………60

中文部份
1.于煥中、吳清平、葉秀逸、王如華 (2000) 以護理觀點談呼吸照護中心成立的初步經驗‧Taiwan Critical Care Medicine, 2, 91-99。
2.中央健康保險局『我國全民健康保險與各國健康照護服務系統現況比較』。
3.中央健康保險局（2009）即時統計資訊，全民健康保險重大傷病證明實際有效領證統計表 (98年11月)。
http://www.nhi.gov.tw/webdata/webdata.asp?menu=1&menu_id=4&webdata_id=805&WD_ID=4
4.中央健康保險局 （2009）「全民健康保險呼吸器依賴患者整合性照護前瞻性支付方式」試辦計畫 第四次修訂 (98年07月24日 -99.01費用月份起適用)。
5.王玉玲、吳杰亮（2008）呼吸器依賴患者之死亡率、生活品質、生活功能與醫療
資源消耗初探－以中部某醫學中心為例。台灣呼吸治療雜誌 7 (2) 79-81。
6.行政院經建會網站 http:// www.cepd.gov.tw/index.jsp 2005。
7.江啟輝 (1998) 急性呼吸衰竭生理學。國防醫學，26（6），418-422。
8.江玲玲 (1992) 呼吸器使用手冊。台北:合記。
9.江玲玲、蔡熒煌、陳淑如、謝文斌 (1993) 長期呼吸器使用的調查研究。長庚醫誌 16(2) ，99-104。
10.何昭中、林梅香、黃人珍(2004)‧重症護理學‧台北：偉華出版社。
11.吳清平、楊式興、蔡珮漪、彭萬誠、顏鴻欽、江啟輝（2000）在醫學中心內心成立的呼吸照護中心使用呼吸器患者一年的預後分析。中華民國重症醫學雜誌，2，1-14。
12.吳清平（2001）長期呼吸器依賴患者整合性照護模式之探討。(衛生署計畫編號： DOH90-TD-1172)。
13.吳清平 (2003)。長期呼吸照器依賴患者整合性照護模式之探討-Ⅱ。(衛生署研究計畫計畫編號：DOH92-TD-1023)。

14.李純馥 (2005) 呼吸器依賴患者整合性照護支付制度之未來展望專題演講。中華民國呼吸照護學會研討會。高雄：義守大學會議廳。
15.吳帆、蔡文正、施純明 (2006) 各國長期呼吸器依賴患者支付方式之研究 (衛生署研究。計畫計畫編號：DOH95-NH-1012) 行政院衛生署。
16.李錦中、姜安波 (1997) 末期肝硬化病患使用呼吸器之預後。Chinese Medical Journal (Taipei) 59 (2):88-94。
17.宋美儀、謝俊民、柯獻欽、鄭高珍（2003）建立呼吸照護中心呼吸器脫離之預測指標。中華民國重症醫學雜誌，5，189-198。
18.林碧華、李俊德、陳寶貝（2003）年齡對呼吸器患者預後的影響‧呼吸治療，1 (1)，61-67。
19.林恆慶、趙儷淨 (2002) 整合性健康照護。台灣公共衛生雜誌，21 (1), 1-8。
20.林金龍 (2003) 全民健康保險呼吸器依賴患者整合照護試辦計畫實施成效之研究。 國立陽明大學醫務管理研究所 碩士論文
21.林燕堂 (2007) 台灣長期呼吸器依賴病患 IDS 整合性照護計畫下呼吸照護病房RCW) 照護結果之分析-以中部地區七間醫院為例。長榮大學醫務管理學系 碩士論文
22.健康保險局網站 htpp://www.nhi.gov.tw。
23.陳慧秦、鄭文輝、林孟志（2008）由家屬的角度探討長期呼吸器依賴患者的照護問題。台灣呼吸治療雜誌 7 (2) 1-19。
24.陳金淵（2000）呼吸器依賴患者試辦管理式照護成效評估。（衛生署研究計畫計畫編號：DOH-89-NH-041）。
25.黃卓禕 李世代 張宏哲 江玲玲 李俊年 (2008）居家呼吸器依賴病患與主要照顧者負荷之初探。台灣呼吸治療雜誌 7 (1) 1-14。
26.楊佩瑄、洪仁宇、楊志仁、蔡忠榮、王東衡、李榮真、黃明賢（2008）台灣呼吸照護中心呼吸器之預測因子。高雄醫誌 2008;24:85-91。

27.蔡熒煌 (2000)。「呼吸器依賴患者整合性照護系統」試辦計畫-臨床作業流程擬定及施行。(衛生署研究計畫計畫編號：DOH-89-NH-043)。台北：行政院衛生署。
28.蔡熒煌 (2002)。呼吸器依賴患者試辦管理式照護及前瞻性支付方式成效評估。(衛生署研究計畫計畫編號：DOH-91-NH-1014)。台北：行政院衛生署。
29.龍芳、林恆慶（2006）管理式醫療與呼吸器依賴患者整合性照護計畫。16（1）63-70。
30.顏簡美珠等 (2002) 呼吸器依賴患者之長期照護模式之建立。(衛生署研究計畫計畫編號：DOH91-NH-1060)。
31.賴美淑、陳真如 (1996) 美國長期呼吸器病患照護考察。行政院衛生署。
32.盧崇正 (1995) 長期使用呼吸器的醫療倫理問題。臨床醫學月刊36 (6): 351-356。
33.蘇千玲、楊式興、吳清平（2006）台灣呼吸照護整合系統現況與未來。呼吸治療期刊16（1）57-62。15 。

英文部份
1.Agusti, A. G. N., Torres A, Estopa R, & Agusti-Vidal A. (1984). Hypophosphatemia as a cause of failed weaning : The importance of metabolic factors. Critical Care Medicine, 12 (2), 142-143.
2.Aubier M. (1988). Respiratory muscle fatigue. Intensive Care Medicine , 8 (15), S17-S20.
3.Afessa B, Hogans L, & Murphy R. (1999). Predicting 3-Day and 7-Day outcomes of weaning from mechanical ventilation. Chest, 116, 456-461.
4.Arabi Y, Haddad S, Shirawi N, Al Shimemeri A. (2004) Early tracheostomy in intensive care trauma patients improves resource utilization: a cohort study and literature review. Crit Care. Oct;8(5):R347-52. Epub 2004 Aug 23.
5.Bergbom-Engberg I, & Haljame H. (1989). Assessment of patient’ experience of discomforts during respirator therapy. Critical Care Medicine, 17(10), 1068-1072.
6.Bagley PH, & Cooney E. (1997). A community-based regional ventilator weaning unit. Chest. 111, 1024-1029.
7.Bone RC, Balk RA.（1998）Noninvasive respiratory care unit. Chest. 93:390-94.
8.Branson RD, (2002). The difficult-to-wean patient.In J.K.Stoller, ED. Bakow, & DL, Longworth,(Eds.) Critical diagnostic thinking in respiratory care:A case-based approach. (pp.289-297).
9.Christie HA, & Goldstein LS. (1999). Respiratory failure and the need for ventilation support. In C.L.Scanlan., R.L.Wilkins & J.K.Stoller (Eds.), EGAN’S Fundamentals of Respiratory Care (7th pp. 819-830). St.Louis：Mosby-Year Book Inc
10.Chatila WM, & Criner GJ. (2002).Complication of long-term mechanical ventilation. Respiratory Care Clinics of North America, 8,631-647.
11.Cox CE, Carson SS, Govert JA, Chelluri L, Sanders GD. (2007) An economic evaluation of prolonged mechanical ventilation. Crit Care Med. Aug; 35(8):1918-27.
12.Daly B J, Rudy EB, Thompson HS.& Happ MB.(1991) Development of a special care unit for chronically ill patients. Heart & Lung, 20(1).45-52.
13.Del Bufalo C, Morelli A, Bassein L, Fasano L, Quarta CC, Pacilli AM, Gunella G. (1995). Severity scores in respiratory intensive care: APACHE II predicted mortality better than SAPS II. Respir Care. Oct; 40(10):1042-7.
14.Dasta JF, McLaughlin TP, Mody SH, Piech CT. (2005) Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med. Jun, 33(6):1266-71.
15.Durbin CG Jr, Perkins MP, Moores LK. (2010) Should tracheostomy be performed as early as 72 hours in patients requiring prolonged mechanical ventilation? Respir Care. Jan; 55(1):76-87.
16.Epstein SK. (2002) Weaning from mechanical ventilation. Respir Care. Apr; 47(4):454-66; discussion 466-8.
17.Epstein SK. (2002). Decision to extubate. Intensive Care Med. 28,535-546.
18.Epstein SK. (2009) Weaning from ventilatory support. Crit Care. Feb;15(1):36-43.
19. Ferrer M, Bernadich O, Nava S, Torres A. (2002) Noninvasive ventilation after intubation and mechanical ventilation. Eur Respir J. May;19(5):959-65.
20. Gracey DR, Viggiano RW, Naessens JM, Hubmayr RD, Silverstein MD.& Koenig GE. (1992). Outcomes of patients ademitted to a chronic ventilator-dependent unit in an acute-care hospital. Mayo Clin Proc, 67(2), 131-136
21.. Gracey DR, Naessens JM, Viggiano RW, Koenig G.E, Silverstein MD, & Hubmayr RD. (1995). Outcomes of patients cared for in a ventilator- dependent unit in a general hospital. Chest.107, 494-499.
22. Heffner JE.(1991) Percutaneous tracheotomy--novel technique or technical novelty?
Intensive Care Med.;17 (5): 252-3
23.Holt TB. (1995) Respiratory failure and the need for ventilatory support , Fundametals of Respiratory care , Louis , mosby-year book ,US.
24.Hilbert G, Choukroun ML, Gbikpi-Benissan G, Guenard H, Cardinaud JP.( 1998) Optimal pressure support level for beginning weaning in patients with COPD: measurement of diaphragmatic activity with step-by-step decreasing pressure support level. J Crit Care. Sep;13 (3):110-8.
25.Hendra, KP., & Celli, B. R. (1999). Weaning from mechanical ventilation. International Anesthesiology Clinics. 37(3), 127-143.
26.Hsu CL, Chen KY, Chang CH, Jerng JS, Yu CJ, Yang PC. (2005) Timing of tracheostomy as a determinant of weaning success in critically ill patients: a retrospective study. Crit Care. Feb;9 (1):R46-52. Epub 2004 Dec 23.
27.Kanus WA, Draper EA, Wagner DP et.al. (1985) APACHE II: aseverity of disease classification system. Crit Care Med.; 13:818-29.
28.Kollef MH, Silver P.(1995).Ventilator-Associated pneumonia. Respiratory Care, 40 (11), 1130-1140.
29.Kollef MH, Ahrens TS, Shannon W. (1999) Clinical predictors and outcomes for patients requiring tracheostomy in the intensive care unit. Crit Care Med.Sep; 27 (9):1714-20.
30.Kriner EJ, Shafazand S, Colice GL. (2005) The endotracheal tube cuff-leak test as a predictor for postextubation stridor. Respir Care. Dec; 50 (12):1632-8.
31.Khilnani GC, Banga A. (2008) Noninvasive ventilation in patients with chronic obstructive airway disease. Int J Chron Obstruct Pulmon Dis.; 3 (3):351-7.
32.Kahn JM, Rubenfeld GD,Rohrbach J, Fuchs BD. (2008) Cost savings attributable to reductions in intensive care unit length of stay for mechanically ventilated patients. Med Care. Dec; 46(12):1226-33.
33.Latriano B, McCauley P, Astiz ME, Greenbaum D. (1996) Non-ICU care of hemodynamically stable mechanically ventilated patients. Chest, 109(6):1591-96.
34.Lindsay ME, Bijwadia JS, Schauer WW, Rozich JD. (2004). Shifting care of chronic ventilator-dependent patients from the intensive care unit to the nursing home. Jt Comm J Qual Saf, 30(5), 257-265
35.McCarthy TP, Yaculak G., and Ringler B. (1998) Areview of 2487 mechanical ventilated patients: ventilator length of stay (VLOS), ICU distribution and mortality, Respiratory Care. 43(2):113-118
36.Mutlu GM.& Factor P.(2000).Complications of mechanical ventilation. Respiratory Care Clinics of North America, 6(2),213-252.
37.Modawal A, Candadai NP, Mandell KM, Hornung RW, Ho ML, Tsevat J. (2002). Weaning success among ventilator-dependent Patients in a rehabilitation facility. Arch Phys Med Rehabil, 83, 154-157.
38.MacIntyre NR. (1995a). Respiratory factors in weaning from mechanical ventilatory support. Respiratory Care. 40(3), 244-248.
39.MacIntyre NR. (1995b). Psychological factora in weaning from mechanical ventilatory support. Respiratory Care. 40(3), 277-281
40.MacIntyre NR. (2004) Evidence-based ventilator weaning and discontinuation. Respir Care. Jul; 49(7):830-6.
41.MacIntyre NR. (2005) Respiratory mechanics in the patient who is weaning from the ventilator. Respir Care. Feb; 50(2):275-86; discussion 284-6.
42.MacIntyre NR. (2006) Muscle dysfunction associated with chronic obstructive pulmonary disease. Respir Care. Aug; 51(8):840-7; discussion 848-52.
43.MacIntyre NR. (2007). Discontinuing mechanical ventilatory support. Chest. Sep; 132(3):1049-56.
44.Norton LC. (1989) Weaning the long-term ventilator dependent patient: common problem and management. Crit Care Nursing. 9,43-52.
45.Niskanen M, Kari A, Nikki P, Iisalo E, Kaukinen L, Rauhala V, Saarela E, Halinen M. (1991) Acute physiology and chronic health evaluation (APACHE II) and Glasgow coma scores as predictors of outcome from intensive care after cardiac arrest. Crit Care Med. Dec; 19 (12):1465-73.
46.O,Donhue WJ.Jr,Giovannoni RM.et al.(1986): Long-term mechanical Ventilation. Guidelines for management in the home and at alternate community sites, Report of the Ad Hoc Committee, Respiratory Care Section, American College of chest physicians,(Review) chest 90(1 suppl):1-37 534-539.
47.Pilbeam SP. (1996). Effects and complications of mechanical ventilation. Mechanical Ventilation-Physiological and clinical applications, (2th ed.). St.Louis.Mosby.
48.Pierson DJ. (2005). Tracheostomy and weaning. Respir Care. Apr; 50(4):526-33.
49.Quinnell TG, Pilsworth S, Shneerson JM, Smith IE. (2006) Prolonged invasive ventilation following acute ventilatory failure in COPD: weaning results, survival, and the role of noninvasive ventilation. Chest. Jan; 129 (1):133-9.
50.Romero J, Vari A, Gambarrutta C, Oliviero A. (2009) Tracheostomy timing in traumatic spinal cord injury. Eur Spine J. Oct; 18(10):1452-7.
51. Scheinhorn DJ, Artinian BM, & Catlin JL. (1994). Weaning from prolonged mechanical ventilation the experience at a regional weaning center. Chest. 105(2), 534-539.
52.Scheinhorn DJ, Chao DC, Stearn-Hassenpflug MA, LaBree LD, & Heltsley DJ. (1997). Post-ICU mechanical ventilation: treatment of 1,123 patients a regional weaning center. Chest. 111, 1654-1659.
53. Sandhu RS, Pasquale MD, Miller K, Wasser TE. (2000).Measurement of endotracheal tube cuff leak to predict postextubation stridor and need for reintubation. J Am Coll Surg. Jun; 190(6):682-7.
54. Scheinhorn DJ, Chao DC.&Stearn-Hassenpflug MA. (2002). Liberation from prolonged mechanical ventilation. Crit Care Clin. 18(3), 569-595.
55.Trevisan CE, Vieira SR; Research Group in Mechanical Ventilation Weaning. Collaborators: Hahn CE, Cassel L, Blom MB, Zancanaro R. (2008) Noninvasive mechanical ventilation may be useful in treating patients who fail weaning from invasive mechanical ventilation: a randomized clinical trial. Crit Care. 12(2):R51. Epub Apr 17.
56.Yang PH, Hung JY, Yang CJ, Tsai JR, Wang TH, Lee JC, Huang MS. (2008) Successful weaning predictors in a respiratory care center in Taiwan. Kaohsiung J Med Sci. Feb; 24(2):85-91.
57.Zilberberg MD, Luippold RS, Sulsky S, Shorr AF.(2008) Prolonged acute mechanical ventilation, hospital resource utilization, and mortality in the United States.Crit Care Med. Mar; 36(3):724-30.
58.Wijkstra PJ. (2003). Non-invasive positive pressure ventilation (NIPPV) in stable patients with chronic obstructive pulmonary disease (COPD). Respir Med. Oct;97(10):1086-93
59. Wu YK, Tsai YH, Lan CC, Huang CY, Lee CH, Kao KC, Fu JY. (2010) Prolonged mechanical ventilation in a respiratory care setting: a comparison of outcome between tracheostomized and translaryngeal intubated patients. Crit Care. Mar 1; 14 (2):R26.