Kantu M, Judkins J, Shulman A
Department of Otolaryngology, State University of New York-Health Science Center at Brooklyn, USA.
Ear Nose Throat J. 1999 Jul;78(7):500-4.
With advances in medical technology and increasing numbers of elderly patients surviving acute intensive care unit admissions, otolaryngologic consultation regarding tracheostomy for ventilator-dependent patients is expected to continue increasing. However, established treatment guidelines and defined outcomes in terms of health status, quality of life, and medical costs are lacking in this emotionally delicate setting. A retrospective case review of the outcomes of 19 elderly patients who underwent tracheostomy for ventilator dependence revealed that 14 had died within 40 days of surgery. The high number of deaths--which were caused by multiple organ failure, sepsis, and/or cardiopulmonary arrest--so soon after tracheostomy demands the implementation of outcomes research. In this article, we introduce outcomes analysis as a means of assessing the utility of tracheostomy for ventilator dependence in the elderly and to advocate the establishment of a multidisciplinary palliative-care unit for this group of patients.
随着医学技术的进步以及急性重症监护病房收治的老年患者存活数量的增加，预计针对依赖呼吸机的患者进行气管切开术的耳鼻喉科会诊数量将持续上升。然而，在这种情感上较为微妙的情况下，缺乏既定的治疗指南以及关于健康状况、生活质量和医疗成本的明确结果。一项对19例因依赖呼吸机而行气管切开术的老年患者的结局进行的回顾性病例分析显示，14例患者在术后40天内死亡。气管切开术后如此短的时间内出现大量由多器官功能衰竭、败血症和/或心肺骤停导致的死亡，这就需要开展结局研究。在本文中，我们介绍结局分析，将其作为评估气管切开术对老年依赖呼吸机患者的效用的一种手段，并倡导为这类患者建立一个多学科姑息治疗单元。
