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首页> 外文期刊>Canadian journal of anesthesia: Journal canadien d'anesthesie >DNR directives are established early in mechanically ventilated intensive care unit patients: (Les directives PDR sont etablies tot chez les patients sous ventilation mecanique a l'unite des soins intensifs).
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DNR directives are established early in mechanically ventilated intensive care unit patients: (Les directives PDR sont etablies tot chez les patients sous ventilation mecanique a l'unite des soins intensifs).

机译：DNR指南在机械通气的重症监护室患者中较早建立：（PDR指南在机械通气的重症监护室患者中较早建立）。

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PURPOSE: Setting treatment goals in the intensive care unit (ICU) often involves resuscitation decisions. Our objective was to study the rate of establishing do-not-resuscitate (DNR) directives, determinants, and outcomes of those directives for mechanically ventilated patients. METHODS: In a multicentre observational study, we included consecutive adults with no DNR directives within 24 hr of ICU admission who were mechanically ventilated for at least 48 hr. We identified the rate with which DNR directives were established, and factors associated with these directives. RESULTS: Among 765 patients, DNR directives were established for 231 (30.2%) patients; 143 (62.1%) of these were established within the first week. Factors independently associated with a DNR directive were: patient age [>/= 75 yr (hazard ratio [HR] 2.3, 95% confidence interval 1.5-3.4], 65 to 74 yr (HR 1.8, 1.2-2.7), 50 to 64 yr (HR 1.4, 1.0-2.2) relative to < 50 yr); medical rather than surgical diagnosis (HR 1.8, 1.3-2.5); multiple organ dysfunction score (HR 1.7 for each five-point increment, 1.4-2.0); physician prediction of ICU survival [< 10% (HR 15.0, 6.7-33.6)], 10 to 40% [(HR 5.0, 2.3-11.2), 41 to 60% (HR 4.0, 1.8-9.0) relative to > 90%]; and physician perception of patient preference to limit life support (no advanced life support [(HR 5.8, 3.6-9.4) or partial advanced life support (HR 3.2, 2.2-4.6) compared to full measures]. CONCLUSION: One third of mechanically ventilated patients had DNR directives established early during their ICU stay after the first 24 hr of admission. The strongest predictors of DNR directives were physician prediction of low probability of survival, physician perception of patient preference to limit life support, organ dysfunction, medical diagnosis and age.
机译：目的：在重症监护病房（ICU）中设定治疗目标通常涉及复苏决策。我们的目标是研究为机械通气患者制定不复苏（DNR）指令，决定因素和这些指令的结果的比率。方法：在一项多中心观察性研究中，我们纳入了在ICU入院24小时内机械通气至少48小时的无DNR指示的连续成年人。我们确定了建立DNR指令的速度以及与这些指令相关的因素。结果：在765名患者中，为231名患者（30.2％）制定了DNR指令;其中143个（62.1％）在第一周内建立。与DNR指令独立相关的因素是：患者年龄[> / = 75岁（危险比[HR] 2.3，95％置信区间1.5-3.4]，65至74岁（HR 1.8，1.2-2.7），50至64岁yr（HR 1.4，1.0-2.2）相对于<50 yr）;医学而不是外科诊断（HR 1.8，1.3-2.5）;多器官功能障碍评分（每五分之差HR 1.7，1.4-2.0）;医师对ICU存活率的预测[<10％（HR 15.0，6.7-33.6）]，10至40％[（HR 5.0，2.3-11.2），41至60％（HR 4.0，1.8-9.0）相对于> 90％ ];和医师对患者偏爱限制生命支持（无高级生命支持[（HR 5.8，3.6-9.4）或部分高级生命支持（HR 3.2，2.2-4.6）相比，采取全面措施的看法]结论：机械通气的三分之一入院后24小时内，患者在ICU停留早期就制定了DNR指令，其中DNR指令最强的预测指标是医师预测生存率低，医师对患者偏爱以限制生命支持，器官功能障碍，医学诊断和年龄的看法。

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