Tracheostomy for ventilator dependence in the elderly patient: A preliminary report

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.