Alayed Tareq, Al-Sowat Waad, Alturki Abdullah, Aljofan Fahad, Alabdulsalam Moath, Alofisan Tariq, Alhuthil Raghad, Alshalawi Munirah, Alghamdi Mansour
Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Crit Care Res Pract. 2025 Jul 2;2025:9948312. doi: 10.1155/ccrp/9948312. eCollection 2025.
To investigate the incidence and determinants of do-not-resuscitate (DNR) orders, as well as mortality-associated risk factors, in the pediatric intensive care unit (PICU) of a tertiary care center in Saudi Arabia. Retrospective cohort study. The PICU at the King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. Patients aged 1 week to 14 years who were admitted to the PICU between January 2021 and December 2023. None. Of the 3344 patients admitted to the PICU, 53.1% were male; the median age was 3 years (interquartile range: 0-8). The most common underlying conditions were neurological in 723 patients (21.6%), hematological/oncological in 463 (13.9%), and cardiovascular in 417 (12.5%). DNR orders were issued for 6.4% of admissions; among the 213 patients with DNR orders, 24 (11.3%) had a history of resuscitation before the DNR order. The mortality rate was significantly higher among patients with DNR orders (42.3%) compared to those without (1.3%; < 0.001). Of all 3344 patients, 130 (3.9%) died; of these, 90 (69.2%) had DNR orders. Predictors of DNR status included male gender, hematological/oncological and cardiovascular diseases, bone marrow transplantation, respiratory distress, sepsis, seizures, bleeding, and need for mechanical ventilation ( < 0.05). This study revealed a DNR order rate of 6.4% among all PICU admissions, with 69.2% of PICU deaths occurring in patients with DNR status. Further analysis is warranted to understand the factors influencing DNR decisions and their impact on patient outcomes.
为调查沙特阿拉伯一家三级医疗中心儿科重症监护病房（PICU）中不进行心肺复苏（DNR）医嘱的发生率、决定因素以及与死亡率相关的危险因素。进行回顾性队列研究。研究地点为沙特阿拉伯利雅得法赫德国王专科医院及研究中心的PICU。研究对象为2021年1月至2023年12月期间入住该PICU的1周龄至14岁患者。无。在3344例入住PICU的患者中，53.1%为男性；中位年龄为3岁（四分位间距：0 - 8岁）。最常见的基础疾病为神经系统疾病，共723例（21.6%），血液学/肿瘤学疾病463例（13.9%），心血管疾病417例（12.5%）。6.4%的入院患者下达了DNR医嘱；在213例有DNR医嘱的患者中，24例（11.3%）在下达DNR医嘱前有复苏史。有DNR医嘱的患者死亡率（42.3%）显著高于无DNR医嘱的患者（1.3%；P < 0.001）。在所有3344例患者中，130例（3.9%）死亡；其中90例（69.2%）有DNR医嘱。DNR状态的预测因素包括男性、血液学/肿瘤学和心血管疾病、骨髓移植、呼吸窘迫、脓毒症、癫痫发作、出血以及需要机械通气（P < 0.05）。本研究显示，所有PICU入院患者中DNR医嘱下达率为6.4%，PICU死亡患者中有69.2%处于有DNR状态。有必要进一步分析以了解影响DNR决策的因素及其对患者结局的影响。
