Rev Med Chil. 2007 May;135(5):669-79. Epub 2007 Jul 9.
In medical practice, the different scenarios in which cardio respiratory resuscitation (CPR) may be applied must be taken into account. CPR is crucial in subjects that arrive in emergency rooms or suffer a cardiac arrest in public places or at their homes. It is also critical in hospitalized patients with potentially reversible diseases, who suffer cardiac arrest as an unexpected event during their evolution. In intensive care units, the decision is particularly complex. The concepts of therapeutic proportionality, treatment futility and therapeutic tenacity can help physicians in their decision making about when CPR is technically and morally mandatory. The do not resuscitate (DNR) decision in taken when a patient is bearing an irreversible disease and his life is coming to an end. DNR decisions are clearly indicated in intensive care units to limit the therapeutic effort and in other hospital facilities, when death is foreseeable and therapeutic tenacity must be avoided. DNR orders must be renewed and reconsidered on a daily basis. It does not mean that other treatment should be discontinued and by no means should the patient be abandoned. DNR and previous directives, DNR and quality of life and DNR communication are also commented in the present article.
在医疗实践中，必须考虑到可能应用心肺复苏术（CPR）的不同场景。CPR对于送达急诊室的患者或在公共场所或家中发生心脏骤停的患者至关重要。对于患有潜在可逆性疾病、在病情发展过程中意外发生心脏骤停的住院患者，CPR也至关重要。在重症监护病房，决策尤为复杂。治疗相称性、治疗无效性和治疗坚持性等概念有助于医生决定何时CPR在技术上和道德上是必需的。当患者患有不可逆转的疾病且生命即将结束时，会做出不进行心肺复苏（DNR）的决定。在重症监护病房明确指示DNR决定以限制治疗努力，在其他医院设施中，当死亡可预见且必须避免治疗坚持性时也适用。DNR医嘱必须每天更新和重新考虑。这并不意味着应停止其他治疗，而且绝不应放弃患者。本文还对DNR与先前指令、DNR与生活质量以及DNR沟通进行了评论。
