急诊-重症监护病房“不复苏”患者的特征和结局。

Characteristics and outcomes of "Do Not Resuscitate" patients admitted to the emergency department-Intensive care unit.

机构信息

Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei City, Taiwan; Department of Emergency Medicine, Taipei Medical University Hospital, Taipei City, Taiwan.

出版信息

J Formos Med Assoc. 2019 Jan;118(1 Pt 2):223-229. doi: 10.1016/j.jfma.2018.03.016. Epub 2018 May 3.

DOI:10.1016/j.jfma.2018.03.016

PMID:29731386

Abstract

BACKGROUND

Appropriate utilization of intensive care unit (ICU) beds are essential. Patients with critical illness who have do not resuscitate (DNR) have a reduced priority of intensive care. However, the possibility of recovery/survival is ambiguous and multifactorial.

OBJECTIVE

To deliberate the characteristics and outcomes of critical illness in patients with prior DNR who were admitted to the emergency department (ED)-ICU.

METHOD

This was a retrospective cohort study conducted between April 2015 and November 2015 in a university-based hospital. Non-traumatic patients with DNR admitted to ED-ICU from ED were included.

RESULTS

Seventy-eight non-trauma patients with prior DNR status were included in the final analysis. 51.3% (40/78) patients were male with median age 83 (IQR: 75-89) years. The median APACHE II score was 24.5 (IQR: 20-30). 50% (39/78) of the DNR patients survived to discharge. Patients who survived to discharge had lower APACHE II score (23 (IQR: 20-28) vs. 28 (18-38), p = 0.028). There was no significant difference in age, gender, and Charlson index. ROC curves were constructed, generating a cut-off of the APACHE II score at 29.5 for determining survival to discharge (AUC = 0.644, p = 0.028). In multivariate Cox proportional model, APACHE II score above 29.5 was an independent predictor for mortality. (Hazard ratio = 2.46; 95% confidence interval: 1.04-5.83, p = 0.042).

CONCLUSION

Our study found that 50% of patients with prior DNR on ICU admission survived to discharge, indicating that aggressive care is not definitely futile. Further prospective studies are required to evaluate the cost-effectiveness and patients' and/or families' satisfaction of the ICU admission of DNR patients.

摘要

背景

合理利用重症监护病房（ICU）床位至关重要。患有不可复苏（DNR）的危重病患者的 ICU 优先级较低。然而，恢复/生存的可能性是不确定的，且是多因素的。

目的

探讨有 DNR 既往史的患者入住急诊重症监护病房（ED-ICU）的危重病特征和结局。

方法

这是一项在 2015 年 4 月至 2015 年 11 月期间在一所大学附属医院进行的回顾性队列研究。纳入从 ED 转入 ED-ICU 的非创伤性 DNR 患者。

结果

最终纳入 78 例非创伤性 DNR 患者进行分析。51.3%（40/78）为男性，中位年龄为 83（IQR：75-89）岁。中位急性生理学与慢性健康状况评分系统 II （APACHE II）评分为 24.5（IQR：20-30）。50%（39/78）的 DNR 患者存活出院。存活出院患者的 APACHE II 评分较低（23（IQR：20-28）vs. 28（18-38），p=0.028）。两组在年龄、性别和 Charlson 指数方面无显著差异。绘制 ROC 曲线，得出 APACHE II 评分 29.5 作为判断出院生存的截断值（AUC=0.644，p=0.028）。多变量 Cox 比例模型分析表明，APACHE II 评分高于 29.5 是死亡的独立预测因素。（危险比=2.46；95%置信区间：1.04-5.83，p=0.042）。