Youngner S J, Lewandowski W, McClish D K, Juknialis B W, Coulton C, Bartlett E T
JAMA. 1985 Jan 4;253(1):54-7. doi: 10.1001/jama.253.1.54.
"Do not resuscitate" (DNR) decisions were examined in a medical intensive care unit (MICU) of a 1,000-bed hospital. Seventy-one (14%) of 506 study patients were designated DNR; nine survived hospitalization. Severity of illness, age, and prior health were predictive of DNR orders; race and socioeconomic factors were not. The DNR patients consumed more resources, both before and after DNR orders. Interventions started before DNR designation were continued in at least 76% of patients. Documented justifications of DNR decisions included poor prognosis (59%), poor quality of life (24%), and patients' wishes (15%). There were no written justifications for the DNR decisions in 30 cases (42%). Although willingness to write DNR orders in an MICU and continued active treatment of DNR patients are both reassuring in a general sense, they raise questions about the consistency of treatment plans and goals for individual patients.
在一家拥有1000张床位医院的医学重症监护病房（MICU）中，对“不要复苏”（DNR）决策进行了研究。506名研究患者中有71名（14%）被指定为DNR；9名患者住院后存活。疾病严重程度、年龄和既往健康状况可预测DNR医嘱；种族和社会经济因素则不然。DNR患者在DNR医嘱下达前后消耗的资源更多。在至少76%的患者中，DNR指定前开始的干预措施仍在继续。记录在案的DNR决策理由包括预后不良（59%）、生活质量差（24%）和患者意愿（15%）。30例（42%）DNR决策没有书面理由。虽然在MICU中开具DNR医嘱的意愿以及对DNR患者继续进行积极治疗总体上都令人安心，但它们也引发了关于个体患者治疗计划和目标一致性的问题。
