Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
BMC Palliat Care. 2024 Feb 15;23(1):42. doi: 10.1186/s12904-024-01375-w.
In the intensive care unit (ICU), we may encounter patients who have completed a Do-Not-Resuscitate (DNR) or a Physician Orders to Stop Life-Sustaining Treatment (POLST) document. However, the characteristics of ICU patients who choose DNR/POLST are not well understood.
We retrospectively analyzed the electronic medical records of 577 patients admitted to a medical ICU from October 2019 to November 2020, focusing on the characteristics of patients according to whether they completed DNR/POLST documents. Patients were categorized into DNR/POLST group and no DNR/POLST group according to whether they completed DNR/POLST documents, and logistic regression analysis was used to evaluate factors influencing DNR/POLST document completion.
A total of 577 patients were admitted to the ICU. Of these, 211 patients (36.6%) had DNR or POLST records. DNR and/or POLST were completed prior to ICU admission in 48 (22.7%) patients. The DNR/POLST group was older (72.9 ± 13.5 vs. 67.6 ± 13.8 years, p < 0.001) and had higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (26.1 ± 9.2 vs. 20.3 ± 7.7, p < 0.001) and clinical frailty scale (5.1 ± 1.4 vs. 4.4 ± 1.4, p < 0.001) than the other groups. Solid tumors, hematologic malignancies, and chronic lung disease were the most common comorbidities in the DNR/POLST groups. The DNR/POLST group had higher ICU and in-hospital mortality and more invasive treatments (arterial line, central line, renal replacement therapy, invasive mechanical ventilation) than the other groups. Body mass index, APAHCE II score, hematologic malignancy, DNR/POLST were factors associated with in-hospital mortality.
Among ICU patients, 36.6% had DNR or POLST orders and received more invasive treatments. This is contrary to the common belief that DNR/POLST patients would receive less invasive treatment and underscores the need to better understand and include end-of-life care as an important ongoing aspect of patient care, along with communication with patients and families.
在重症监护病房（ICU），我们可能会遇到已签署拒绝心肺复苏（DNR）或医生指令停止维持生命治疗（POLST）文件的患者。然而，选择 DNR/POLST 的 ICU 患者的特征尚不清楚。
我们回顾性分析了 2019 年 10 月至 2020 年 11 月期间入住我们医院 ICU 的 577 名患者的电子病历，重点关注根据患者是否完成 DNR/POLST 文件的特征。根据是否完成 DNR/POLST 文件，患者被分为 DNR/POLST 组和无 DNR/POLST 组，并使用逻辑回归分析评估影响 DNR/POLST 文件完成的因素。
共有 577 名患者入住 ICU。其中，211 名（36.6%）患者有 DNR 或 POLST 记录。48 名（22.7%）患者在入住 ICU 前完成了 DNR 和/或 POLST。DNR/POLST 组年龄较大（72.9±13.5 岁 vs. 67.6±13.8 岁，p<0.001），急性生理学和慢性健康评估（APACHE）II 评分较高（26.1±9.2 分 vs. 20.3±7.7 分，p<0.001）和临床虚弱量表评分较高（5.1±1.4 分 vs. 4.4±1.4 分，p<0.001）。实体瘤、血液恶性肿瘤和慢性肺部疾病是 DNR/POLST 组最常见的合并症。DNR/POLST 组 ICU 死亡率和院内死亡率较高，侵入性治疗（动脉置管、中心静脉置管、肾脏替代治疗、有创机械通气）更多。体重指数、APACHE II 评分、血液恶性肿瘤、DNR/POLST 是院内死亡率的相关因素。
在 ICU 患者中，36.6%有 DNR 或 POLST 医嘱，并接受更多的侵入性治疗。这与 DNR/POLST 患者将接受较少侵入性治疗的普遍看法相悖，这突显了需要更好地理解并将临终关怀作为患者护理的一个重要持续方面，以及与患者和家属进行沟通的重要性。
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