An Outcome Analysis of Mechanically Ventilated Middle Aged and Elderly Taiwanese Patients Undergoing Tracheostomy

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• 作者：Yueh-Chih Chung¹ ; ^&dagger ; ; Kuo-Hwa Chiang² ; ⁷ ; Chin-Li Lu³ ; Hsing-Min Chen² ; Mei-Chen Huang⁴ ; Kuo-Chen Cheng¹ ; ² ; ⁵ ; ⁶ ; ^{kcg.cheng@gmail.com}
• 关键词：hospice ; mechanical ventilators ; tracheotomy ; utilization
• 刊名：International Journal of Gerontology
• 出版年：2013
• 出版时间：June, 2013
• 年：2013
• 卷：7
• 期：2
• 页码：70-74
• 全文大小：157 K

文摘

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class=""h3"">Summary

class=""h4"">Background

The primary goal in critically ill patients who are mechanically ventilated is to wean from the ventilator. Higher weaning rates have been noted in patients undergoing mechanical ventilation following tracheostomy. The purpose of this study was to clarify the current status of tracheostomy execution in mechanically ventilated middle-aged and elderly patients.

class=""h4"">Methods

Patients admitted to the intensive care unit (ICU) aged ¡Ý 45 years, mechanically ventilated on at least one occasion after undergoing tracheostomy, were included by using hospitalization registration records that had been submitted to the Bureau of National Health Insurance between March 2004 and February 2009. We analyzed the current status of tracheostomy execution and the risk factors for mortality.

class=""h4"">Results

We enrolled a total of 453,939 patients ever using ventilators, with 29,128 of them (20,059 men and 9069 women) undergoing tracheostomies. The tracheostomy rate was 6.4 % among patients who were mechanically ventilated. The mean age was 72 years. The mean RW value was 4.78. The mean ICU days, total hospital days, ventilator days, and mortality rate were highest in patients aged ¡Ý 75 years, followed by patients aged 65-74 years. The medical expenses were highest in patients aged 65-74 years, followed by those aged ¡Ý 75 years. The tracheostomy rate showed the strongest decline in patients aged ¡Ý 75 years, followed by patients aged 65-74 years. Sex, age, hospital level, the duration of mechanical ventilation, and medical and antibiotic expenses were identified as risk factors for mortality (p < 0.001).

class=""h4"">Conclusions

This study demonstrated that the utilization of medical resources and the decline in the number of tracheostomies performed were higher in patients aged ¡Ý 65 compared to patients under 65.