Do-not-intubate status and COVID-19 mortality in patients admitted to Dutch non-ICU wards

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Geriatric Medicine

Background:

• COVID-19 significantly increases mortality in elderly patients requiring mechanical ventilation.
• Treatment outcomes for COVID-19 patients with do-not-intubate (DNI) status remain largely unknown.
• Elderly patients often present with multiple comorbidities and higher care dependency.

Purpose of the Study:

• To investigate the mortality rate and clinical characteristics of COVID-19 patients with DNI status admitted to a non-ICU ward.
• To compare outcomes between COVID-19 patients with and without DNI orders.
• To highlight the importance of advanced care planning in managing COVID-19 patients.

Main Methods:

• Retrospective analysis of 100 COVID-19 patients admitted to a non-ICU ward during the initial phase of the pandemic.
• Data collection included patient demographics, comorbidities, care dependency, and DNI status.
• Mortality rates were compared between patients with and without DNI orders.

Main Results:

• The mortality rate among COVID-19 patients with a DNI order was 49%.
• Patients with DNI orders were significantly older, had more comorbidities, and exhibited greater care dependency.
• Mortality in the DNI subgroup was three times higher than in non-DNI patients, but comparable to published rates for elderly, mechanically ventilated patients.

Conclusions:

• COVID-19 patients with DNI status face a substantially higher mortality risk, particularly older individuals with comorbidities.
• The findings underscore the critical need for proactive advanced care planning in COVID-19 management.
• Facilitating patient autonomy and preventing potentially non-beneficial interventions are key ethical considerations.