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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Erschienen in:

27.04.2022 | Reports of Original Investigations

Outcomes of prolonged mechanical ventilation and tracheostomy in critically ill elderly patients: a historical cohort study

verfasst von: Tiffany Lee, MD, FRCPC, Qiao Li Tan, MBBS, MRCP, Tasnim Sinuff, MD, MSc, FRCPC, Alex Kiss, PhD, Sangeeta Mehta, MD, FRCPC

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 9/2022

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Abstract

Purpose

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.

Methods

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.

Results

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%).

Conclusions

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.

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United Nations Department of Economic and Social Affairs. World population ageing 2019. Available from URL: https://www.un-ilibrary.org/content/books/9789210045544 (accessed February 2022).

Abe T, Madotto F, Pham T, et al. Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries. Crit Care 2018; https://doi.org/10.1186/s13054-018-2126-6.CrossRefPubMedPubMedCentral

Aquino-Esperanza J, Pelosi P, Blanch L. What’s new in intensive care: tracheostomy—what is known and what remains to be determined. Intensive Care Med 2019; 45: 1619–21.PubMedCrossRef

Mehta AB, Syeda SN, Bajpayee L, Cooke CR, Walkey AJ, Wiener RS. Trends in tracheostomy for mechanically ventilated patients in the United States, 1993-2012. Am J Respir Crit Care Med 2015; 192: 446–54.PubMedPubMedCentralCrossRef

Frutos-Vivar F, Esteban A, Apezteguía C, et al. Outcome of mechanically ventilated patients who require a tracheostomy. Crit Care Med 2005; 33: 290–8.PubMedCrossRef

Freeman BD, Morris PE. Tracheostomy practice in adults with acute respiratory failure. Crit Care Med 2012; 40: 2890–6.PubMedCrossRef

Nieszkowska A, Combes A, Luyt CE, et al. Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients. Crit Care Med 2005; 33: 2527–33.PubMedCrossRef

Koch T, Hecker B, Hecker A, et al. Early tracheostomy decreases ventilation time but has no impact on mortality of intensive care patients: a randomized study. Langenbecks Arch Surg 2012; 397: 1001–8.PubMedCrossRef

Hyde GA, Savage SA, Zarzaur BL, et al. Early tracheostomy in trauma patients saves time and money. Injury 2015; 46: 110–4.PubMedCrossRef

10.

Young D, Harrison DA, Cuthbertson BH, Rowan K, Collaborators T. Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial. JAMA 2013; 309: 2121–9.PubMedCrossRef

11.

Baskin JZ, Panagopoulos G, Parks C, Rothstein S, Komisar A. Clinical outcomes for the elderly patient receiving a tracheotomy. Head Neck 2004; 26: 71–5.PubMedCrossRef

12.

Engoren MC, Arslanian-Engoren CM. Outcome after tracheostomy for respiratory failure in the elderly. J Intensive Care Med 2005; 20: 104–10.PubMedCrossRef

13.

Kantu M, Judkins J, Shulman A. Tracheostomy for ventilator dependence in the elderly patient: a preliminary report. Ear, Nose Throat J 1999; 78: 500–4.PubMedCrossRef

14.

Chung YC, Chiang KH, Lu CL, Chen HM, Huang MC, Cheng KC. An outcome analysis of mechanically ventilated middle aged and elderly taiwanese patients undergoing tracheostomy. Int J Gerontol 2013; 7: 70–4.CrossRef

15.

Drendel M, Primov-Fever A, Talmi YP, Roziner I, Wolf M, Migirov L. Outcome of tracheostomy in patients over 85 years old (oldest-old patients). Otolaryngol Head Neck Surg 2009; 140: 395–7.PubMedCrossRef

16.

Tamir SO, Khalaily N, Einav S, Shemesh S, Gluck O, Marom T. 30-day morbidity and mortality rates in elderly subjects following surgical tracheostomy. Respir Care 2018; 63: 1009–15.PubMedCrossRef

17.

Cohen O, Shapira-Galitz Y, Shnipper R, et al. Outcome and survival following tracheostomy in patients ≥ 85 years old. Eur Arch Otorhinolaryngol 2019; 276: 1837–44.PubMedCrossRef

18.

Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173: 489–95.PubMedPubMedCentralCrossRef

19.

Vargas M, Sutherasan Y, Brunetti I, et al. Mortality and long-term quality of life after percutaneous tracheotomy in intensive care unit: a prospective observational study. Minerva Anestesiol 2018; 84: 1024–31.PubMedCrossRef

20.

Herridge MS, Chu LM, Matte A, et al. The recover program: disability risk groups and 1-year outcome after 7 or more days of mechanical ventilation. Am J Respir Crit Care Med 2016; 194: 831–44.PubMedCrossRef

21.

Johnson MS, Bailey TL, Schmid KK, Lydiatt WM, Johanning JM. A frailty index identifies patients at high risk of mortality after tracheostomy. Otolaryngol Head Neck Surg 2014; 150: 568–73.PubMedCrossRef

22.

Fernando SM, McIsaac DI, Rochwerg B, et al. Frailty and invasive mechanical ventilation: association with outcomes, extubation failure, and tracheostomy. Intensive Care Med 2019; 45: 1742–52.PubMedCrossRef

23.

Heyland DK, Garland A, Bagshaw SM, et al. Recovery after critical illness in patients aged 80 years or older: a multi-center prospective observational cohort study. Intensive Care Med 2015; 41: 1911–20.PubMedCrossRef

24.

Mehta AB, Walkey AJ, Curran-Everett D, Douglas IS. One-year outcomes following tracheostomy for acute respiratory failure. Crit Care Med 2019; 47: 1572–81.PubMedPubMedCentralCrossRef

25.

Ceriana P, Carlucci A, Schreiber A, et al. Changes of swallowing function after tracheostomy: a videofluoroscopy study. Minerva Anestesiol 2015; 81: 389–97.PubMed

26.

Skoretz SA, Anger N, Wellman L, Takai O, Empey A. A systematic review of tracheostomy modifications and swallowing in adults. Dysphagia 2020; 35: 935–47.PubMedPubMedCentralCrossRef

27.

Pryor L, Ward E, Cornwell P, O’Connor S, Chapman M. Patterns of return to oral intake and decannulation post-tracheostomy across clinical populations in an acute inpatient setting. Int J Lang Commun Disord 2016; 51: 556–67.PubMedCrossRef

28.

Robbins J, Hamilton JW, Lof GL, Kempster GB. Oropharyngeal swallowing in normal adults of different ages. Gastroenterology 1992; 103: 823–9.PubMedCrossRef

29.

9. Pannunzio TG. Aspiration of oral feedings in patients with tracheostomies. AACN Clin Issues 1996; 7: 560–9.PubMedCrossRef

30.

Muscedere J, Waters B, Varambally A, et al. The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis. Intensive Care Med 2017; 43: 1105–22.PubMedPubMedCentralCrossRef

31.

Brummel NE, Bell SP, Girard TD, et al. Frailty and subsequent disability and mortality among patients with critical illness. Am J Respir Crit Care Med 2017; 196: 64–72.PubMedPubMedCentralCrossRef

32.

Ferrante LE, Pisani MA, Murphy TE, Gahbauer EA, Leo-Summers LS, Gill TM. The association of frailty with post-ICU disability, nursing home admission, and mortality: a longitudinal study. Chest 2018; 153: 1378–86.PubMedPubMedCentralCrossRef

33.

Flaatten H, De Lange DW, Morandi A, et al. The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years). Intensive Care Med 2017; 43: 1820–8.PubMedCrossRef

34.

Shears M, Takaoka A, Rochwerg B, et al. Assessing frailty in the intensive care unit: a reliability and validity study. J Crit Care 2018; 45: 197–203.PubMedCrossRef

35.

Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet 2013; 381: 752–62.PubMedCrossRef

36.

Leung R, MacGregor L, Campbell D, Berkowitz RG. Decannulation and survival following tracheostomy in an intensive care unit. Ann Otol Rhinol Laryngol 2003; 112: 853–8.PubMedCrossRef

37.

Jacob G, Jakab M, Ray J. Characteristics and outcomes of patients who underwent bedside surgical tracheostomy performed in the intensive care unit: a retrospective study. Can J Anesth 2018; 65: 327–8.PubMedCrossRef

38.

Hernández G, Ortiz R, Pedrosa A, et al. The indication of tracheotomy conditions the predictors of time to decannulation in critical patients. Med Intensiva 2012; 36: 531–9.PubMedCrossRef

39.

O'Connor HH, Kirby KJ, Terrin N, Hill NS, White AC. Decannulation following tracheostomy forprolonged mechanical ventilation. J Intensive Care Med 2009; 24: 187–94.PubMedCrossRef

40.

Scheinhorn DJ, Hassenpflug MS, Votto JJ, et al. Post-ICU mechanical ventilation at 23 long term care hospitals. Chest 2007; 131: 85–93.PubMedCrossRef

41.

Schneider H, Hertel F, Kuhn M, et al. Decannulation and functional outcome after tracheostomy in patients with severe stroke (DECAST): a prospective observational study. Neurocrit Care 2017; 27: 26–34.PubMedCrossRef

42.

Freeman-Sanderson AL, Togher L, Elkins M, Kenny B. Quality of life improves for tracheostomy patients with return of voice: a mixed methods evaluation of the patient experience across the care continuum. Intensive Crit Care Nurs 2018; 46: 10–6.PubMedCrossRef

43.

Kim YK, Choi JH, Yoon JG, Lee JW, Choi SS. Improved dysphagia after decannulation of tracheostomy in patients with brain injuries. Ann Rehabil Med 2015; 39: 778–85.PubMedPubMedCentralCrossRef

44.

O’Connor HH, White AC. Tracheostomy decannulation. Respir Care 2010; 55: 1076–81.PubMed

45.

de Medeiros GC, Sassi FC, Lirani-Silva C, de Andrade CR. Criteria for tracheostomy decannulation: literature review. Codas 2019; https://doi.org/10.1590/2317-1782/20192018228.CrossRefPubMed

46.

Pelosi P, Ball L, Brunetti I, Vargas M, Patroniti N. Tracheostomy in intensive care: patients and families will never walk alone! Anaesth Crit Care Pain Med 2018; 37: 197–9.PubMedCrossRef

47.

Ceriana P, Carlucci A, Navalesi P, et al. Weaning from tracheotomy in long-term mechanically ventilated patients: feasibility of a decisional flowchart and clinical outcome. Intensive Care Med 2003; 29: 845–8.PubMedCrossRef

Titel: Outcomes of prolonged mechanical ventilation and tracheostomy in critically ill elderly patients: a historical cohort study
verfasst von: Tiffany Lee, MD, FRCPC
Qiao Li Tan, MBBS, MRCP
Tasnim Sinuff, MD, MSc, FRCPC
Alex Kiss, PhD
Sangeeta Mehta, MD, FRCPC
Publikationsdatum: 27.04.2022
Verlag: Springer International Publishing
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 9/2022
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-022-02263-8

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Outcomes of prolonged mechanical ventilation and tracheostomy in critically ill elderly patients: a historical cohort study

Abstract

Purpose

Methods

Results

Conclusions

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