概括
在医疗重症监护室,研究了"不复苏" (DNR) 的决定. 疾病严重程度等因素预测了DNR命令,持续干预是常见的,这引发了对一致的患者护理目标的质疑.
科学领域:
- 医学伦理 医学伦理
- 临界护理医学 临界护理医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 在医疗重症监护室 (MICU) 中,不复苏 (DNR) 命令至关重要.
- 了解影响DNR决策和资源利用的因素对于患者护理至关重要.
研究的目的:
- 在MICU中检查DNR命令的患者的特征.
- 为了确定DNR指定的预测因素.
- 分析DNR决策的资源消耗和证明文件.
主要方法:
- 追溯分析506名患者在1000床医院的MICU.
- 鉴定了71名DNR订单的患者 (14%).
- 分析临床数据,人口统计和文档.
主要成果:
- 疾病的严重程度,年龄和先前的健康状况预测了DNR订单;种族和社会经济因素没有.
- DNR患者在订单前和订单后消耗更多的资源.
- 持续干预是常见的 (≥76%).
- 预后不佳 (59%) 是主要记录的原因,42%缺乏书面证明.
结论:
- 在MICU中,DNR决策受到临床因素的影响,而不是人口因素.
- 在DNR指定后继续进行激进治疗,引发了对护理一致性的担忧.
- 需要改进DNR决策理由的文档.
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