在重症监护室,有"不要复苏"的命令. 目前的做法和最近的变化
R L Jayes1, J E Zimmerman, D P Wagner
1Department of Medicine, George Washington University Medical Center, Washington, DC 20037.
JAMA
|November 10, 1993
概括
医生在重症监护室 (ICU) 写不复苏 (DNR) 命令的频率越来越高,时间也越来越早. 这种转变反映了改善的沟通和对结果的理解,导致更好的患者护理和降低死亡率.
科学领域:
- 临界护理医学 临界护理医学
- 医学伦理 医学伦理
- 医疗保健服务研究 医疗服务研究
背景情况:
- 不复苏 (DNR) 命令对于在重症监护室 (ICU) 的终身护理决策至关重要.
- 了解DNR订单频率和时间的趋势对于评估重症监护实践至关重要.
研究的目的:
- 在ICU中描述DNR命令的患者.
- 在全国ICU样本中确定DNR命令的频率和时间.
- 为了比较1980-1990年和早期 (1979-1982) 的DNR实践.
主要方法:
- 预期的开始队列研究.
- 从美国40家医院的42个重症监护室收集的数据 (1988-1990年).
- 分析了17,440次连续的ICU入院病例,包括患者人口统计,并发病症和疾病严重程度.
主要成果:
- 在9%的ICU入院中存在DNR命令,在各医院之间存在显著差异.
- 受DNR命令的患者年龄较大,并患上更多的并发症和更严重的疾病.
- 集中护理DNR订单从5.4% (1979-1982) 增加到9% (1988-1990),订单更早,死亡率更高.
结论:
- 医生和家人正在为预后不佳的患者早些时候和更频繁地设定护理限制.
- 更多的对话和对治疗结果的了解可能会推动这些实践变化.
- 这些趋势在"患者自决权法案"之前出现,突出了不断变化的终身护理讨论.
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