Timing is everything: Early do-not-resuscitate orders in the intensive care unit and patient outcomes.

Autor: Ouyang DJ; Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, United State of America., Lief L; Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, United State of America.; Department of Medicine, Weill Cornell Medicine, New York, New York, United State of America., Russell D; Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, United State of America.; Department of Sociology, Appalachian State University, Boone, North Carolina, United State of America., Xu J; Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, United State of America., Berlin DA; Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, United State of America.; Department of Medicine, Weill Cornell Medicine, New York, New York, United State of America., Gentzler E; Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, United State of America., Su A; Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, United State of America., Cooper ZR; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United State of America., Senglaub SS; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United State of America., Maciejewski PK; Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, United State of America.; Department of Medicine, Weill Cornell Medicine, New York, New York, United State of America.; Department of Radiology, Weill Cornell Medicine, New York, New York, United State of America., Prigerson HG; Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, United State of America.; Department of Medicine, Weill Cornell Medicine, New York, New York, United State of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2020 Feb 18; Vol. 15 (2), pp. e0227971. Date of Electronic Publication: 2020 Feb 18 (Print Publication: 2020).
DOI: 10.1371/journal.pone.0227971
Abstrakt: Background: The use of Do-Not-Resuscitate (DNR) orders has increased but many are placed late in the dying process. This study is to determine the association between the timing of DNR order placement in the intensive care unit (ICU) and nurses' perceptions of patients' distress and quality of death.
Methods: 200 ICU patients and the nurses (n = 83) who took care of them during their last week of life were enrolled from the medical ICU and cardiac care unit of New York Presbyterian Hospital/Weill Cornell Medicine in Manhattan and the surgical ICU at the Brigham and Women's Hospital in Boston. Nurses were interviewed about their perceptions of the patients' quality of death using validated measures. Patients were divided into 3 groups-no DNR, early DNR, late DNR placement during the patient's final ICU stay. Logistic regression analyses modeled perceived patient quality of life as a function of timing of DNR order placement. Patient's comorbidities, length of ICU stay, and procedures were also included in the model.
Results: 59 patients (29.5%) had a DNR placed within 48 hours of ICU admission (early DNR), 110 (55%) placed after 48 hours of ICU admission (late DNR), and 31 (15.5%) had no DNR order placed. Compared to patients without DNR orders, those with an early but not late DNR order placement had significantly fewer non-beneficial procedures and lower odds of being rated by nurses as not being at peace (Adjusted Odds Ratio namely AOR = 0.30; [CI = 0.09-0.94]), and experiencing worst possible death (AOR = 0.31; [CI = 0.1-0.94]) before controlling for procedures; and consistent significance in severe suffering (AOR = 0.34; [CI = 0.12-0.96]), and experiencing a severe loss of dignity (AOR = 0.33; [CI = 0.12-0.94]), controlling for non-beneficial procedures.
Conclusions: Placement of DNR orders within the first 48 hours of the terminal ICU admission was associated with fewer non-beneficial procedures and less perceived suffering and loss of dignity, lower odds of being not at peace and of having the worst possible death.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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