Unintended Consequences of Code Status in the Intensive Care Unit: What Happens After a Do-Not-Resuscitate Order Is...

Area of Science:

• Critical Care Medicine
• Medical Ethics
• Health Services Research

Background:

• Clinicians may limit aggressive care for patients with do-not-resuscitate (DNR) orders.
• This extrapolation may lead to significant harm by altering goals of care.
• Understanding the impact of DNR orders on invasive interventions is crucial.

Purpose of the Study:

• To investigate whether do-not-resuscitate (DNR) orders in the intensive care unit (ICU) are associated with a decrease in invasive interventions.
• To compare the utilization of specific invasive procedures between ICU patients with and without DNR orders.

Main Methods:

• Retrospective cohort study of ICU patients across three teaching hospitals.
• Inclusion criteria focused on patients with DNR orders, excluding those with medical futility, comfort care, or early discharge.
• Primary outcomes included surgical operations, central lines, ventilation, dialysis, and other procedures post-DNR initiation.

Main Results:

• Patients with DNR orders had fewer surgical operations but more central lines, ventilator use, and dialysis compared to full code patients.
• Antibiotic administration and blood transfusions showed similar trends in both groups.
• Mortality and hospice discharges were significantly higher for patients with DNR orders.

Conclusions:

• Do-not-resuscitate (DNR) status in the ICU did not result in a wholesale decrease in invasive interventions.
• While specific intervention rates varied, patients with DNR orders received a comparable number of non-operative invasive procedures.
• Findings suggest that code status limitations do not necessarily lead to reduced invasive care for ICU patients.