识别"不尝试复苏"命令的流行率和潜在预测因素,以促进对代码状态的手术前讨论
Kelly Cheung1, Alex Saffran1, Ashton Engdahl1
1Virginia Commonwealth University, Richmond, VA, USA.
The American journal of hospice & palliative care
|July 30, 2024
概括
在住院期间,不尝试复苏 (DNAR) 命令的流行率从2.4%增加到7.4%. 麻醉科医生可以使用临床因素来识别需要代码状态讨论的患者.
科学领域:
- 医学伦理 医学伦理
- 麻醉学 麻醉学
- 患者护理 患者护理
背景情况:
- 不要尝试复苏 (DNAR) 命令使患者能够拒绝复苏.
- 美国麻醉学会 (ASA) 倡导进行外科手术期间的代码状态讨论.
- 了解DNAR患病率和预测因素对于将护理与患者目标相协调至关重要.
研究的目的:
- 确定DNAR订单在入院和出院时的流行率.
- 确定DNAR状态的人口和临床预测因素.
- 帮助麻醉医生促进及时的代码状态对话.
主要方法:
- 对患者数据的回顾性分析.
- 统变逻辑回归用于评估与DNAR状态相关的因素.
- 评估的变量包括年龄,种族,性别,息护理参与,停留时间,手术,护理水平和医疗服务.
主要成果:
- DNAR订单的流行率从入院时的2.4%上升到退院时的7.4%.
- 入院时的预测因素与先前的研究一致 (年龄,息治疗).
- 在出院时,重要的预测因素包括停留时间,紧急手术,更高的护理水平和瘤/呼吸器ICU服务.
结论:
- 该研究确定了关键的临床特征,以预测DNAR状态的变化.
- 麻醉科医生可以在代码状态讨论中主动参与患有已识别的风险因素的患者.
- 改进的外科手术前沟通可以增强以患者为中心的护理,并防止不必要的干预.
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