DNR directives are established early in mechanically ventilated intensive care unit patients |
| |
Authors: | Tasnim Sinuff Deborah J. Cook Graeme M. Rocker Lauren E. Griffith Stephen D. Walter Malcolm M. Fisher Peter M. Dodek Peter Sjokvist Ellen McDonald John C. Marshall Peter A. Kraus Mitchell M. Levy Neil M. Lazar Gordon H. Guyatt |
| |
Affiliation: | 1. Department of Medicine, McMaster University, Hamilton, Ontario, Canada 2. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada 4. Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada 5. Intensive Therapy Unit, Royal North Shore Hospital, University of Sydney, Sydney, Australia 6. Program of Critical Care Medicine and Center for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada 7. Department of Anesthesia and Intensive Care, Huddinge University, Stockholm, Sweden 8. Department of Surgery, University of Toronto, Toronto, Ontario, Canada 9. Department of Medicine, Brown University, Providence, Rhode Island, USA 10. Department of Medicine, University of Toronto and University Health Network, Toronto, Ontario, Canada
|
| |
Abstract: | Purpose Setting treatment goals in the intensive care unit (ICU) often involves resuscitation decisions. Our objective was to study the rate of establishing do-not-resuscitate (DNR) directives, determinants, and outcomes of those directives for mechanically ventilated patients. Methods In a multicentre observational study, we included consecutive adults with no DNR directives within 24 hr of ICU admission who were mechanically ventilated for at least 48 hr. We identified the rate with which DNR directives were established, and factors associated with these directives. Results Among 765 patients, DNR directives were established for 231 (30.2%) patients; 143 (62.1%) of these were established within the first week. Factors independently associated with a DNR directive were: patient age [> 75 yr (hazard ratio [HR] 2.3, 95% confidence interval 1.5–3.4], 65 to 74yr(HR 1.8, 1.2–2.7), 50 to 64 yr (HR 1.4, 1.0–2.2) relative to < 50 yr); medical rather than surgical diagnosis (HR 1.8, 1.3–2.5); multiple organ dysfunction score (HR 1.7 for each five-point increment, 1.4–2.0); physician prediction of ICU survival [< 10% (HR 15.0, 6.7–33.6)], 10 to 40% [(HR 5.0, 2.3–11.2), 41 to 60% (HR 4.0, 1.8–9.0) relative to > 90%]; and physician perception of patient preference to limit life support (no advanced life support [(HR 5.8, 3.6–9.4) or partial advanced life support (HR 3.2, 2.2–4.6) compared to full measures]. Conclusion One third of mechanically ventilated patients had DNR directives established early during their ICU stay after the first 24 hr of admission. The strongest predictors of DNR directives were physician prediction of low probability of survival, physician perception of patient preference to limit life support, organ dysfunction, medical diagnosis and age. |
| |
Keywords: | |
本文献已被 SpringerLink 等数据库收录! |
|