随着台湾经济起飞，20世纪60年代各大医院先后成立加护病房，其管理及照顾质量在1995年卫生管理部门办理加护病房评鉴后，逐渐上轨道。在全民健康保险论量计酬制度下，加护病房持续扩张，以10万人口之加护病房床数统计，台湾地区为30张。重症医学专科医师联合甄审委员会及6个重症相关医学会，负责办理重症医学专科医师考试与资格审查。重症专责医师制度，联合护理师、呼吸治疗师、营养师、临床药师、复健师、社工师组成治疗团队，对于病人提供全面性照护。经过半个世纪的发展，台湾重症医学已建立自己的重症准则，提高重症治疗的质量。战胜败血症治疗准则的教育训练，显著降低败血症病患的死亡率。但仍面临严峻的考验——偏低的健保给付、严格的评鉴规定、过多的医疗纠纷、超长的工作时数，阻碍年轻医护人员持续于重症前线服务的意愿。对未来的展望，除临床照顾外，更应进行基础的重症研究，改善照护流程，为重症病患提供精确有效率的照顾。%Intensive care unit (ICU) was established in the major medical centers during 1960s following Taiwanʹs economic growth. The standard of care was safeguarded by the Accreditation of Department of Health since 1995. National health insurance and fee for service payment system energized the expansion of ICU. The ICU bed per 100 000 populations was 30 during 2012. A joint committee comprise of 6 critical care related societies are responsible for the examination and accreditation of Intensivest. The establishment of critical care team- nurses, respiratory therapist, clinical pharmacist and dietitian under the lead of Intensivest provide integrated care. After half century of development, we build up our care guidelines and improve the care quality. The implementation surviving sepsis guidelines significantly reduce the mortality rate of septic patients. However, challenges are ahead, inadequate reimbursement, excessive work load and malpractice charges are negative incentives for the young practitioners. Our future perspective will put more efforts on scientific research and re-engineering our care process in order to provide an effective and efficient care for the critically ill patients.
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