在COVID-19的住院患者中的代码状态命令
Amber R Comer1,2,3, Lyle Fettig2, Stephanie Bartlett1
1Indiana University School of Health and Human Science, United States.
Resuscitation plus
|September 4, 2023
概括
在COVID-19大流行期间,不尝试心肺复苏 (DNACPR) 和不输管 (DNI) 的命令在大流行初期更为常见. 这些订单对于早期住院的患者来说更早,尽管有类似的临床因素.
科学领域:
- 医学伦理 医学伦理
- 关键护理医学 关键护理医学
- 公共卫生 公共卫生
背景情况:
- 随着COVID-19大流行,临终关怀决策面临着重大的伦理和临床挑战.
- 这包括对住院患者的不尝试心肺复苏 (DNACPR) 和不插管 (DNI) 命令的适当时间和利用.
研究的目的:
- 在COVID-19流行病的不同阶段调查DNACPR和/或DNI订单的利用模式.
- 在COVID-19患者中确定与这些订单相关的预测因素,时间和结果.
主要方法:
- 进行了一项队列研究,涉及两家中西部医院的1375名住院COVID-19患者.
- 收集的数据包括人口统计,实验室结果,治疗,临床干预和结果 (死亡率,出院处置,临终关怀).
- 患者被分为早期 (2020年3月至10月) 和晚期的流行病队伍.
主要成果:
- 19%的患者有记录的DNACPR和/或DNI命令.
- 在大流行期间,年龄较大和早期住院与DNACPR订单有关.
- 从DNACPR命令到死亡的时间在早期队列中 (5天) 与晚期队列 (2天) 相比较短,尽管住院死亡率没有差异.
结论:
- DNACPR/DNI订单更为普遍,并且在疫情早期入院的患者的医院课程中更早地进行.
- 尽管具有相似的临床特征和干预措施,但这些变化可能反映了与流行病相关的因素,如资源问题和不断发展的知识.
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