Tracheostomy for Ventilator Dependence in the Elderly Patient: A Preliminary Report

Kantu, Manoj; Judkins, Jennifer; Shulman, Abraham

doi:10.1177/014556139907800712

Cited by 5 publications

(3 citation statements)

References 6 publications

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“…Few studies have evaluated outcomes in elderly, severely ill patients requiring tracheotomies. At least one other study reported data similar to those presented here,7; namely, that a tracheotomy may not always constitute the best airway management in the elderly and severely ill patient with respiratory failure.…”

Section: Discussionsupporting

confidence: 76%

Clinical outcomes for the elderly patient receiving a tracheotomy

et al. 2003

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Background. 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.Methods. 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.Results. The mean age was 77.6 F 11 years (median, 79 years), and patients were intubated for 16.7 F 9 days. Fortytwo 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.Conclusions. These data demonstrate that a large proportion of elderly, severely ill patients with respiratory failure suffer poor outcomes after tracheotomy. This number is expected to double by the year 2030. Health care costs in the United States for the over-65 population was $1740 billion (38% of total expenditures) in 1996. This figure is estimated to jump to $15,970 billion (74% of total expenditures) by 2030.2 As care improves and more elderly patients survive in the acute-care setting, the number of patients with prolonged respiratory failure will continue to increase.

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Section: Discussionsupporting

confidence: 76%

Clinical outcomes for the elderly patient receiving a tracheotomy

et al. 2003

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“…The long-term outcomes in this patient population are known to be poor, and even the short-term mortality rates are significant. 1,2 The relatively high likelihood of poor short-term outcomes in these patients compels the clinician to look for ways to identify those with a better chance for short-term survival. Clearly, tracheotomy is not always indicated in patients who have a high probability of short-term mortality, but to the knowledge of the authors, there have not been any studies to assess the reliability of prognostic indicators in this patient population.…”

Section: Introductionmentioning

confidence: 99%

Predicting Outcome in Aged and Severely Ill Patients with Prolonged Respiratory Failure

Baskin¹,

Panagopoulos²,

Parks³

et al. 2005

Ann Otol Rhinol Laryngol

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“…[1][2][3][4][5][6] Patients with persistent airway obstruction have continued benefit from prolonged tracheotomy, and removal is contraindicated.…”

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confidence: 99%

What About the Trach? Tracheotomy Removal as a Palliative Care Maneuver

Newman

Kvale

Williams

et al. 2007

Am J Hosp Palliat Care

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Tracheotomy is performed on patients with airway obstruction or prolonged mechanical ventilation. Tracheotomy patients are increasingly being referred to hospice and palliative care. This case series describes a process for evaluating the ongoing need for tracheotomy and the impact of tracheotomy removal. A retrospective cohort design was used in which charts were reviewed of all tracheotomy patients referred to the palliative care unit between November 1, 1998, and July 31, 2001. Tracheotomy was present in 13 of 791 palliative care unit admissions. Persistent airway obstruction contraindicated tracheotomy removal in 5 patients. The remaining patients had a successful "button" trial with subsequent tracheotomy removal. They incurred no complications and exhibited improved functional status and decreased symptom burden. Tracheotomy removal is safe and beneficial in this patient subset and should be considered an alternative to prolonged tracheotomy.

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Tracheostomy for Ventilator Dependence in the Elderly Patient: A Preliminary Report

Cited by 5 publications

References 6 publications

Clinical outcomes for the elderly patient receiving a tracheotomy

Clinical outcomes for the elderly patient receiving a tracheotomy

Predicting Outcome in Aged and Severely Ill Patients with Prolonged Respiratory Failure

What About the Trach? Tracheotomy Removal as a Palliative Care Maneuver

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