Faculty of Health Sciences, School of Medicine, University of Adelaide, North Tce., Adelaide, SA, Australia.
Resuscitation. 2013 Aug;84(8):1035-9. doi: 10.1016/j.resuscitation.2013.01.021. Epub 2013 Jan 29.
Compare and contrast rapid response team (RRT) calls to patients with, and those without, a pre-existing not for resuscitation (NFR) order.
Retrospective medical record and database review of adult inpatients with a hospital stay greater than 24h.
198 (15.7%) of 1258 patients with a RRT call, had a pre-existing NFR order. Patients with, compared to those without a pre-existing NFR, were older (median years, 81 vs 70, p<0.01), similar gender (males, 56.6% vs 54.3%, p=0.55), the trigger be the worried criterion (48.5% vs 33.9%, p<0.01) and have had a prior RRT call (30.8% vs 18.0%, p<0.01). At time of RRT attendance, NFR patients had a higher respiratory rate (24 vs 20, p<0.01), lower SaO2 (93% vs 97%, p=0.02) and just as likely to receive a critical care (24.2% vs 25.8%, p=0.63) or ward type (88.9% vs 90.1%, p=0.61) intervention. NFR patients were less likely to be admitted to an ICU (2.0% vs 9.4%, p<0.01), more likely to be left on the ward (92.4% vs 80.3%, p<0.01), and be documented not for further RRT calls (2.5% vs 0.9%, p=0.06), but have a similar mortality (5.6% vs 3.5%, p=0.16), at time of RRT call.
RRT calls to patients with pre-existing NFR orders are not uncommon. The worried criterion is more often the trigger, they have abnormal respiratory observations at time of call, a similar level of intervention, less likely to be admitted to the ICU and more likely to be documented not for further RRT calls.
比较并对比有和没有预先存在的不复苏（NFR）医嘱的快速反应团队（RRT）呼叫患者。
回顾性分析住院时间超过 24 小时的成年住院患者的病历和数据库。
在 1258 名接受 RRT 呼叫的患者中，有 198 名（15.7%）有预先存在的 NFR 医嘱。与没有预先存在 NFR 医嘱的患者相比，有 NFR 医嘱的患者年龄更大（中位数年龄，81 岁与 70 岁，p<0.01），性别相似（男性，56.6%与 54.3%，p=0.55），触发标准为担忧标准（48.5%与 33.9%，p<0.01），并且之前有过 RRT 呼叫（30.8%与 18.0%，p<0.01）。在 RRT 就诊时，NFR 患者的呼吸频率更高（24 次与 20 次，p<0.01），SaO2 更低（93%与 97%，p=0.02），接受重症监护（24.2%与 25.8%，p=0.63）或病房类型（88.9%与 90.1%，p=0.61）干预的可能性相同。NFR 患者入住 ICU 的可能性较小（2.0%与 9.4%，p<0.01），留在病房的可能性较大（92.4%与 80.3%，p<0.01），并且记录不再需要进一步的 RRT 呼叫（2.5%与 0.9%，p=0.06），但在 RRT 呼叫时的死亡率相似（5.6%与 3.5%，p=0.16）。
有预先存在的 NFR 医嘱的 RRT 呼叫并不少见。担忧标准更常作为触发标准，他们在呼叫时的呼吸观察异常，干预水平相似，入住 ICU 的可能性较小，更有可能记录不再需要进一步的 RRT 呼叫。
