Sabouneh R, Lakissian Z, Hilal N, Sharara-Chami R
American University of Beirut Medical Centre (AUBMC).
Dar Al-Wafaa Simulation in Medicine (DAWSIM), AUBMC.
J Palliat Care. 2022 Apr;37(2):99-106. doi: 10.1177/08258597211073228. Epub 2022 Jan 11.
The Do-Not-Resuscitate (DNR) order is part of most hospitals' policies on the process of making and communicating decisions about a patient's resuscitation status. Yet it has not become a part of our society's ritual of dying in the Middle East especially among children. Given the diversity of pediatric patients, the DNR order continues to represent a challenge to all parties involved in the care of children including the medical team and the family. This was a retrospective review of the medical charts of patients who had died in the pediatric intensive care unit (PICU) of a tertiary academic institution in Beirut, Lebanon within the period of January 2012 and December 2017. Eighty-two charts were extracted, 79 were included in the analysis. Three were excluded as one patient had died in the Emergency Department (ED) and 2 charts were incomplete. Most patients were male, Lebanese, and from Muslim families. These patients clinically presented with primary cardiac and oncological diseases or were admitted from the ED with respiratory distress or from the operating room for post-operative management. The primary cause of death was multiorgan failure and cardiac arrest. Only 34% of families had agreed to a DNR order prior to death and 10% suggested "soft" resuscitation. Most discussions were held in the presence of the parents, the PICU team and the patient's primary physician. The DNR order presents one of the most difficult challenges for all care providers involved, especially within a culturally conservative setting such as Lebanon. As the numbers suggest, it is difficult for parents to reach the decision to completely withhold resuscitative measures for pediatric patients, instead opting for "soft" resuscitations like administering epinephrine without chest compressions.
“不要复苏”（DNR）医嘱是大多数医院关于制定和传达患者复苏状态决策流程政策的一部分。然而，在中东地区，尤其是在儿童群体中，它尚未成为我们社会临终仪式的一部分。鉴于儿科患者的多样性，DNR医嘱对包括医疗团队和家庭在内的所有参与儿童护理的各方来说仍然是一个挑战。这是一项对2012年1月至2017年12月期间在黎巴嫩贝鲁特一家三级学术机构的儿科重症监护病房（PICU）死亡患者的病历进行的回顾性研究。提取了82份病历，79份纳入分析。排除3份，1例患者在急诊科死亡，2份病历不完整。大多数患者为男性，黎巴嫩人，来自穆斯林家庭。这些患者临床上表现为原发性心脏和肿瘤疾病，或因呼吸窘迫从急诊科入院，或从手术室转入进行术后管理。主要死亡原因是多器官衰竭和心脏骤停。只有34%的家庭在患者死亡前同意DNR医嘱，10%建议进行“温和”复苏。大多数讨论是在家长、PICU团队和患者的主治医生在场的情况下进行的。对于所有参与护理的人员来说，DNR医嘱是最具挑战性的问题之一尤其是在黎巴嫩这样一个文化保守的环境中。正如数据所示，家长很难做出完全放弃对儿科患者进行复苏措施的决定，而是选择“温和”复苏，如不进行胸外按压只注射肾上腺素。
