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Do-not-resuscitate practices in the chronically critically ill

B J Daly1, J Gorecki, A Sadowski

  • 1Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106-4904, USA.

Heart & Lung : the Journal of Critical Care
|July 1, 1996
PubMed
Summary
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Do-not-resuscitate (DNR) orders were equally frequent in special care and intensive care units. DNR patients were older, had worse mental status, and a significantly higher mortality rate compared to non-DNR patients.

Area of Science:

  • Critical Care Medicine
  • Medical Ethics
  • Health Economics

Background:

  • The chronically critically ill population presents unique challenges for end-of-life care decisions.
  • Do-not-resuscitate (DNR) orders are a crucial component of advance care planning in intensive care settings.
  • Understanding the factors influencing DNR orders and their impact on patient outcomes and costs is essential.

Purpose of the Study:

  • To determine the frequency of DNR orders in chronically critically ill patients.
  • To compare clinical and demographic characteristics of patients with and without DNR orders.
  • To analyze the cost of care and DNR practices in a special care unit versus a traditional intensive care unit (ICU).

Main Methods:

  • A randomized, prospective study design with block randomization was employed.
Keywords:
Death and EuthanasiaEmpirical ApproachUniversity Hospitals of Cleveland

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  • Two hundred twenty eligible patients were enrolled, meeting specific criteria for ICU stay and acuity scores.
  • Data collected included clinical and demographic variables, mental status, timing of DNR orders, mortality, and hospitalization costs.

    • Main Results:

    • No significant difference in DNR order frequency was observed between the special care unit and the ICU.
    • Patients with DNR orders were older, less likely to be married, and had higher initial acuity scores.
    • The mortality rate was substantially higher in the DNR group (71%) compared to the non-DNR group (6%), with no difference in total costs.

    Conclusions:

    • DNR order practices did not differ significantly in frequency between the two unit types, though timing varied.
    • Patient characteristics, including age and mental status, were associated with DNR order status.
    • The significantly higher mortality in DNR patients underscores the importance of advance care planning and communication in critical care settings.