Carrillo-Alcaraz Andres, Guia Miguel, Tornero-Yepez Pilar, López-Gomez Laura, Alonso-Fernandez Nuria, Martin Lorenzo Juan Gervasio, Sanchez Nieto Juan Miguel
Intensive Care Unit, Morales Meseguer Hospital, Av Marqués de los Vélez, s/n, 30008 Murcia, Spain.
Sleep and Non-Invasive Ventilation Unit, Thorax Department, Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz MB, 1649-02, Lisbon, Portugal; ISAMB, Instituto de Saúde Ambiental da Faculdade de Medicina da Universidade de Lisboa, Av. Professor Egas Moniz 1649-028 Lisbon, Portugal.
Med Intensiva (Engl Ed). 2025 Mar 10:502169. doi: 10.1016/j.medine.2025.502169.
The main purpose of this study was to analyze the prevalence of do-not-intubate (DNI) orders in patients admitted to an Intensive Care Unit (ICU) due to acute respiratory failure (ARF) and who were treated with non-invasive ventilation (NIV). The secondary objective was to correlate the presence of a DNI order with the patient's prognosis.
Retrospective observational study.
Polyvalent ICU.
All consecutively admitted ICU patients for ARF between January 1, 1997, and December 31, 2022, who were treated with NIV.
Initial clinical variables, NIV failure rate, complications, in-hospital and one-year mortality.
5972 patients were analyzed, 1275 (21.3%) presenting a DNI order. The mean age was 68.2 ± 14.9; 60.2% were male. The most frequent cause of DNI order was chronic respiratory disease (452 patients; 35.5%). Patients with DNI order were older, had higher Charlson comorbidity index and higher frailty. NIV failure occurred in 536 (42.0%) patients in the DNI order group vs. 1118 (23.8%) in the non-DNI order group (p < 0.001). In-hospital mortality was higher in patients with DNI order (57.9% vs 16.4%; p < 0.001). The adjusted OR for inhospital mortality was 2.14 (95% CI 1.98 to 2.31).
DNI orders are common in patients with ARF treated with NIV and they related to worse short and long-term prognosis.
本研究的主要目的是分析因急性呼吸衰竭（ARF）入住重症监护病房（ICU）并接受无创通气（NIV）治疗的患者中不插管（DNI）医嘱的发生率。次要目的是将DNI医嘱的存在与患者的预后相关联。
回顾性观察研究。
综合性ICU。
1997年1月1日至2022年12月31日期间因ARF连续入住ICU并接受NIV治疗的所有患者。
初始临床变量、NIV失败率、并发症、住院期间及一年死亡率。
共分析了5972例患者，其中1275例（21.3%）有DNI医嘱。平均年龄为68.2±14.9岁；男性占60.2%。开具DNI医嘱最常见的原因是慢性呼吸系统疾病（452例患者；35.5%）。有DNI医嘱的患者年龄更大，Charlson合并症指数更高且虚弱程度更高。DNI医嘱组536例（42.0%）患者发生NIV失败，而非DNI医嘱组为1118例（23.8%）（p<0.001）。有DNI医嘱的患者住院死亡率更高（57.9%对16.4%；p<0.001）。住院死亡率的校正比值比为2.14（95%置信区间1.98至2.31）。
DNI医嘱在接受NIV治疗的ARF患者中很常见，且与短期和长期预后较差相关。
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