If you have an intuition your patients older than 65 are at increased risk of infection, especially pneumonia (4-11 times the risk of the under 65 cohorts), you are correct.
If you are concerned your patients co-morbidities, such as COPD, heart disease, and malnutrition will contribute to prolonged mechanical ventilation (the rate of VAP increases 1-3% every extra day on the vent), you are correct.
After age 70, the ICU length of stay and duration of mechanical ventilation increase by 5 days and 9 days respectively.
In the age of COVID-19, itself associated with prolonged mechanical ventilation, it's fair to prepare patients and families for this. We are fortunate we do not need to ration ventilators, so our discussions remain centered on the wishes of our patients, informed by a realistic understanding of what treatment and recovery entail.
Additional Information
References
Esme M, Topeli A, Yavuz B, et al. Infections in the Elderly Critically-Ill Patient. Frontiers in Medicine 2019; 6: 118.
