DNR directives are established early in mechanically ventilated intensive care unit patients
- 1 December 2004
- journal article
- research article
- Published by Springer Science and Business Media LLC in Canadian Journal of Anesthesia/Journal canadien d'anesthésie
- Vol. 51 (10), 1034-1041
- https://doi.org/10.1007/bf03018494
Abstract
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. 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. 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]. 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. Le choix des objectifs de traitement à l’unité des soins intensifs (USI) comprend souvent des décisions concernant la réanimation. Notre but était d’étudier le taux d’ordonnance «pas de réanimation» (PDR), les déterminants et les conséquences de ces directives pour tes patients ventiiés mécaniquement. Lors d’une étude par observation muiticentrique, nous avons indus des adultes pour qui la directive PDR avait été émise au cours des 24 premières heures de présence à l’USI et qui étaient sous ventiiation mécanique depuis au moins 48 h. Nous avons déterminé te taux de directives PDR étabiies et ies facteurs qui y sont associés. Parmi 765 patients, il y a eu des directives PDR dans 231 (30,2 %) des cas; 143 (62,1 %) d’entre elles à l’intérieur de la première semaine. Les facteurs indépendamment associés à la directive PDR ont été : l’âge du patient [ = 75 ans (risque relatif [RR] de 2,3, intervalle de confiance de 95 % 1,5-3,4], 65 à 74 ans (RR de 1,8, 1,2–2,7), 50 à 64 ans (RR de 1,4, 1,0-2,2) par rapport à < 50 ans) ; le diagnostic médical plutôt que chirurgical (RR de 1,8, 1,3-2,5) ; le score de défaillance multiviscérale (RR de 1,7 pour chaque...Keywords
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