Goal Due to the development of medical technology, implementation of national health insurance (NHI) program and population aging, the increasing of ventilator-dependent patients are significant within these years. Patients with the catastrophic illness certification spent about 26.2% NHI medical resource. Oncology, hemodialysis and ventilator-dependent patients were thought to be the most resource utilized ones. The objective of this study was to find the possible risk of reintubation on those ventilator-dependent patients. So, that we may reduce the reintubation rate and shorten their hospital stays. Method This study was a retrospective study based on the database of a local teaching hospital. During 2005 and 2010, patients aged older than 17 years old and required more than 3 weeks of mechanical ventilation support were selected. Here were total 313 cases include 247 successful weaning and 66 reintubation. Statistical analysis included descriptive statistic, Chi-square test and logistic regression by SPSS® for windows. Risk factors included their demographic features, acute physiology and chronic health evaluation (APACHE) II scoring system as well as laboratory data. Results The ages of successful weaning and reintubation patients were 72¡Ó15 vs. 76¡Ó15, p=0.092 years old, respectively. APACH II score (17¡Ó8 vs. 22¡Ó8, p<0.001), BUN (33.2¡Ó26 vs. 43.0¡Ó33 mg/dL, p=0.033), K+ (3.8¡Ó0.8 vs. 4.2¡Ó0.9 mmol/L, p=0.002), Ca+ (8.0¡Ó0.8 vs. 8.6¡Ó0.9 mmol/L, p=0.007), WBC (13880¡Ó7270 vs. 17720¡Ó9540, p=0.003), Hb (11.8¡Ó2.5 g/dL vs. 10.3¡Ó1.4 g/dL, p<0.001), Platelet (224400¡Ó106310 vs. 284570¡Ó119160,p=0.001). However, Logistic regression found two significant factors were APACHE II (odds ratio [OR], 2.97), Hb (OR, 0.701). By means of ROC curves, we derived the critical values of reintubation risk due to Hb as 11.3 g/dL respectively. Conclusion Based on the results, we inference that the reintubation risk increases up to 1.2 per unit APACHE II score while decreases 45% per unit Hb. It is suggested that if clinical physician could keep Hb of patients above 11.3 g/dL respectively, the reintubation rate may be significantly reduced.

According to the report of the Bureau of National Healthcare Insurance (NHI) in 1997, the total expenses on ventilator-dependent patients was about 7,100 million yuan in hospital, account for 3% of the cost of one year of health insurance of the whole people. To efficiently control their admission so as to decrease unsuitable utilization of mechanical ventilation, and to achieve the rational growth of medical expenditure, the NHI has developed the perspective payment system for the ventilator-dependent integrated delivery system (IDS) respiratory care program since July 1, 2000. Ventilator-dependent patients, difficult to wean, rely on the mechanical ventilation, using for at least 21 days in succession. The patients are dependent upon long-term mechanical respiratory care. Integrating the different level of respiratory care, IDS program is including ¡§ICU , intensive care unit¡¨, ¡¨RCC, respiratory care center¡¨, ¡¨ RCW , respiratory care ward¡¨ and ¡§home care¡¨ and pay in accordance with the level. The purpose of IDS program is to promote the quality of respiratory care and effectively to utilize the limited medical resources. The data for this research was retrieved from the 2002-2004 ¡§NHI database¡¨ that includes charge and discharge information for 115 hospitals. Of the 115 hospitals analyzed using data envelopment analysis (DEA) technique, to explore the whole efficiency and purely technological efficiency.

Background¡G Ventilator-dependent patients have a great and far-reaching impact on families. Their primary caregivers, who are usually the ventilator-dependent patients¡¦ families, have played important roles during the caring process. Those caregivers are burdened with a lot of responsibility and pressure. It is crucial to find out how to assist the caregivers within selected methods of caring and to provide them with suitable needs in order to reduce their psychological burden. Therefore, the purpose of this study is to explore the related factors and to compare the burden and the needs of the primary caregivers in respiratory care ward and home care on long-term ventilator-dependent patients. Design¡G The survey adopts cross-sectional and purposive sampling by using a structured questionnaire to collect information. Both Burden and Needs Questionnaire¡¦s reliability is respectively 0.923 and 0.943; their KMO is 0.828 and 0.829 ; their Expert Validity (CVI) is 0.88 and 0.91. The questionnaire has reached the ideal value of reliability and validity. The sampling subjects are from respiratory care ward and home care centers in southern Taiwan. Total 260 out of 280 questionnaires are returned (the response rate has reached 92.9%) and there are 241 valid samples. The questionnaires are used for data collection and are divided into four sections; ¡§patient basic information¡¨ , ¡§family basic information¡¨, ¡§caregiver burden scale¡¨, and ¡§caregiver need scale ¡¨. The collected data is analyzed with descriptive statistics-test, one-way ANOVA, Pearson¡¦s correlation and multiple regressions by using SPSS Windows version 12.0. Result¡G (1) Patients from Home-care centre are normally younger in comparison with the patients from respiratory care wards; their average usage of mechanical ventilator is 30.98 month longer; they tend to have more conscious and tracheotomy patients. According to the demography, these two groups of the patients have a significant difference. (2) The average age of primary home care and respiratory care ward caregivers is 50¡ã52; most of them are female; most of the care givers are the patients¡¦ children. (3) "Physiological burdens" and "physiological needs" of home care centers caregivers are greater than the caregivers in respiratory care ward. They have reached a significant difference in statistic. (4) The primary caregivers have a declining health, and their workload and demands are increasing. (5) There is a significant positive correlation between the primary caregivers¡¦ burden and needs. (6) Base on the numbers of admitting to the ICU, the hospital and the current health status of the primary caregivers; the workload is predictable. Conclusion¡G Hopefully the result of this study can provide the Government to formulate a long-term-care insurance. Focus on providing the services to different needs for the caregivers; reduce the caregivers¡¦ burden on caring the mechanical ventilator patients. Also, to provide health care workers and respiratory therapists to implement on transferring patients to respiratory care ward and to offer further health education for the primary caregivers of home care centers.

The research investigates, qualitatively, the experience of primary caregivers of children who are ventilator-dependent and cared for at home. Advances in medical and nursing knowledge and technology have improved the biological outcome of children who are critically ill. As a result, there is an increasing number of children in hospital who are medically stable, however dependent upon long-term respiratory support. Due to the increasing change from healthcare delivery to home care, some ventilator-dependent children are discharged to their primary caregivers who undertake the medical and technical care of the children in their home. A review of the literature indicates limited research examining and addressing issues of pediatric home ventilation. Information concerning the experience and needs of the primary caregivers of an in-home ventilator-dependent child is thus unavailable for effective and appropriate clinical interventions and policy implementation. To address the gap in the literature, a phenomenographic research approach was used to identify and describe a limited number of qualitatively different ways in which the primary caregivers understood their experience of caring for a ventilator-dependent child at home. An in-depth interview was undertaken with each of those seventeen participants and recorded on audiotape for transcribing verbatim. Data was sorted using a qualitative software program--ATLAS.ti.--and analysed using a series of seven analytical steps recommended for a phenomenographic research (Dahlgren and Fallsberg, 1991). The outcomes of the research are seven categories of description with each representing a conception of the experience, and all categories combined constituting an outcome space that presents the structural relations between conceptions. The seven categories of description representing the care-giving experiences of the primary caregivers are: (1) 'Hospital is another world to me'; (2) 'It's a new world'; (3) An ambiguous social identity;(4) The medical technology associated with my child is frightening but necessary;(5) 'The difficulty is having the carers at home'; (6) Social isolation; and (7) The experience of changing as a person. Discussions on the outcomes of the research indicate a need for increased understanding of the 'new world' of the primary caregivers and a recognition and acknowledgement of the distinctive nature of the experience in caring for a ventilator-dependent child at home. Hence, increased financial, respite, psychological and social support are of central importance, in addition to ongoing healthcare research, education, and practice for appropriate policy development, implementation and evaluation.

Thesis "Care of ventilator-dependent patienl wilh spinal cord injury in Czech republic" deals with problems of high cervica\ spinal cord les ion wilh diaphragm para\ysis. Generally introduces clinical manifestation of the spinal cord injury, classifícation of spinal cord lesions and statistical data regarding the incidence, prevalence and etiology. In more detail focuses on respiratory problems. Contains survey of most conunon respiratory complications in ventilator-dependent quadriplegic patients and infonn about the possibililies of respiralory physiotherapy. The practical part provides the first description of the Czech population of pentaplegics. Truough case studies indroduces health and livíng conditíons of persons wíth high spinal cord lesion and need of mechanical ventilation. Powered by TCPDF (www.tcpdf.org)