Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore.
Can J Anaesth. 2022 Sep;69(9):1107-1116. doi: 10.1007/s12630-022-02263-8. Epub 2022 Apr 27.
With an aging global population, the increased proportion of elderly patients in the intensive care unit (ICU) raises important questions regarding optimal management. Currently, data on tracheostomy and its outcomes in the elderly are limited. We aimed to determine the in-hospital survival of elderly ICU patients following tracheostomy, and describe impacts on discharge disposition and functional outcomes.
We conducted a historical cohort study at two academic hospitals in Toronto. All patients aged ≥ 70 yr who received a tracheostomy during their ICU stay between January 2010 and June 2016 were included in a retrospective chart review. Data on patient demographics, frailty, tracheostomy indication, and outcomes were collected.
The study included 270 patients with a mean (standard deviation) age of 81 (6) yr. The majority were admitted to ICU for respiratory failure (147/270, 54%) and received a tracheostomy for prolonged mechanical ventilation (202/270, 75%). Intensive care unit and hospital mortality were 26% (68/270) and 46% (125/270), respectively. Twenty-five percent (67/270) of patients were decannulated during hospital admission, a median [interquartile range (IQR)] of 41 [25-68] days after tracheostomy. Intensive care unit and hospital length of stay were 31 [17-53] and 81 [46-121] days, respectively. At hospital discharge, 6% (17/270) of patients were discharged home, all were frail (median Clinical Frailty Score of 7) and most were tube-fed (101/270, 70%), unable to speak (81/270, 56%), and nonambulatory (98/270, 68%).
In patients aged ≥ 70 yr, tracheostomy during ICU stay marked a transition toward prolonged chronic critical illness. Nearly half of the patients died during the admission, and although a quarter were successfully decannulated, the majority of survivors were left with severe frailty and functional impairment.
随着全球人口老龄化，重症监护病房（ICU）中老年患者的比例增加，这对最佳治疗方案提出了重要问题。目前，关于老年人气管切开术及其结果的数据有限。我们旨在确定 ICU 中老年人气管切开术后的院内生存率，并描述对出院去向和功能结果的影响。
我们在多伦多的两家学术医院进行了一项历史性队列研究。所有在 2010 年 1 月至 2016 年 6 月期间在 ICU 住院期间接受气管切开术的年龄≥70 岁的患者均纳入回顾性病历审查。收集患者人口统计学、脆弱性、气管切开术指征和结果的数据。
该研究纳入了 270 例平均（标准差）年龄为 81（6）岁的患者。大多数患者因呼吸衰竭（147/270，54%）入住 ICU，并因长时间机械通气（202/270，75%）接受气管切开术。重症监护病房和医院死亡率分别为 26%（68/270）和 46%（125/270）。25%（67/270）的患者在住院期间被拔管，气管切开术后中位数[四分位距（IQR）]为 41[25-68]天。重症监护病房和医院的住院时间分别为 31[17-53]天和 81[46-121]天。出院时，6%（17/270）的患者出院回家，均为虚弱（中位数临床虚弱评分 7），大多数为管饲喂养（270，70%）、无法说话（270，56%）和非活动性（270，68%）。
在年龄≥70 岁的患者中，ICU 期间的气管切开术标志着向长期慢性危重病的转变。近一半的患者在住院期间死亡，尽管四分之一的患者成功拔管，但大多数存活者仍存在严重的虚弱和功能障碍。
