Baskin Jonathan Zvi, Panagopoulos Georgia, Parks Christine, Rothstein Stephen, Komisar Arnold
Department of Otolaryngology and Head and Neck Surgery, New York University School of Medicine, 1317 3rd Ave., New York, New York 10021, USA.
Head Neck. 2004 Jan;26(1):71-5. doi: 10.1002/hed.10356.
Tracheotomies are routinely performed for severely ill and elderly patients with respiratory failure. This intervention is questioned, given the poor survival rate in this group. Outcomes analysis is performed after tracheotomy.
This is a retrospective study of 78 elderly patients, who received tracheotomies for respiratory failure. Pretracheotomy data (age, length of oral intubation, and DNR status) were collected. Outcomes analyzed during the same admission as the tracheotomy included death versus discharge, ventilator dependence, vocal function, route of feeding, decannulation, and ICU discharge disposition.
The mean age was 77.6 +/- 11 years (median, 79 years) and patients were intubated for 16.7 +/- 9 days. Forty-two percent (n = 33) obtained DNR orders after tracheotomy, and 8% (n = 6) before tracheotomy. Seventy-one percent of patients (n = 55) had gastrostomy tubes placed. Fifty-six percent of patients (n = 44) died after tracheotomy; median time from tracheotomy to death was 31 days. After tracheotomy, 53 % (n = 41) remained at least partially ventilator dependent, 18 % (n = 14) regained consistent vocal function, and 13 % (n = 10) were decannulated. For those who died, 27 % (n = 12) died without leaving the ICU.
These data demonstrate that a large proportion of elderly, severely ill patients with respiratory failure suffer poor outcomes after tracheotomy. More stringent criteria are necessary for performing the tracheotomy in this patient population.
对于患有呼吸衰竭的重症老年患者，气管切开术是常规操作。鉴于该群体的低生存率，这种干预措施受到质疑。气管切开术后进行了结果分析。
这是一项对78例因呼吸衰竭接受气管切开术的老年患者的回顾性研究。收集了气管切开术前的数据（年龄、经口插管时间和不进行心肺复苏状态）。在与气管切开术同一住院期间分析的结果包括死亡与出院、呼吸机依赖、发声功能、喂养途径、拔管和重症监护病房出院处置情况。
平均年龄为77.6±11岁（中位数为79岁），患者经口插管16.7±9天。42%（n = 33）的患者在气管切开术后获得了不进行心肺复苏的医嘱，8%（n = 6）在气管切开术前获得。71%的患者（n = 55）放置了胃造瘘管。56%的患者（n = 44）在气管切开术后死亡；从气管切开术到死亡的中位时间为31天。气管切开术后，53%（n = 41）的患者至少部分依赖呼吸机，18%（n = 14）恢复了持续发声功能，13%（n = 10）拔管。对于死亡的患者，27%（n = 12）在未离开重症监护病房的情况下死亡。
这些数据表明，很大一部分患有呼吸衰竭的老年重症患者在气管切开术后预后不佳。对于该患者群体，进行气管切开术需要更严格的标准。
