Lantos J D, Berger A C, Zucker A R
Section of Pediatric Critical Care Medicine, Center for Clinical Medical Ethics, Chicago, IL.
Crit Care Med. 1993 Jan;21(1):52-5. doi: 10.1097/00003246-199301000-00012.
a) To quantify the use of do-not-resuscitate orders in a tertiary care children's hospital; and b) to characterize the circumstances in which such orders are written.
Retrospective chart review.
University teaching hospital.
All inpatients who died in an urban children's hospital over a 1-yr period of time.
None.
The hospital records of 54 of 69 patients who died were reviewed. Eighty-two percent of patient deaths occurred in the ICU; 13% of patient deaths occurred in the operating room, and 5% occurred in a medical ward. Other findings included the following: 25 (46%) of 54 patients died after attempted cardiopulmonary resuscitation; 13 (24%) patients were brain dead; and 16 (30%) died with a do-not-resuscitate order in effect. Age was associated with resuscitation status: do-not-resuscitate orders were written for five (21%) of 22 infants (< 1 yr of age); seven (50%) of 14 children (1 to 11 yrs of age); and four (80%) of five adolescents who died (p < .002). Fifteen of 16 do-not-resuscitate orders were written for patients who were in the ICU, where they remained until death. Findings in patients when the do-not-resuscitate orders were written were as follows: 15 ICU patients were receiving mechanical ventilation; 14 (95%) of 15 were receiving inotropic agents; 12 (80%) of 15 patients were receiving narcotic analgesics; and one (6%) patient was being dialyzed. At least one therapeutic modality was withdrawn in 7 (44%) of 16 patients. Do-not-resuscitate orders followed documented conferences with physicians and family members in 13 (81%) of 16 cases. These discussions were initiated by physicians in 12 (92%) of 13 cases.
Do-not-resuscitate orders in pediatric patients are written more often in older than younger hospitalized children who die. Most do-not-resuscitate orders are written for patients who are receiving aggressive medical therapy in the ICU.
a）量化一家三级儿童专科医院中“不要复苏”医嘱的使用情况；b）描述开具此类医嘱的情况。
回顾性病历审查。
大学教学医院。
在1年期间于一家城市儿童医院死亡的所有住院患者。
无。
对69例死亡患者中的54例的医院记录进行了审查。82%的患者死亡发生在重症监护病房（ICU）；13%的患者死亡发生在手术室，5%发生在内科病房。其他发现包括：54例患者中有25例（46%）在尝试心肺复苏后死亡；13例（24%）患者脑死亡；16例（30%）在“不要复苏”医嘱生效的情况下死亡。年龄与复苏状态相关：22例婴儿（<1岁）中有5例（21%）开具了“不要复苏”医嘱；14例儿童（1至11岁）中有7例（50%）；5例死亡青少年中有4例（80%）（p<0.002）。16例“不要复苏”医嘱中有15例是为ICU中的患者开具的，这些患者一直留在ICU直至死亡。开具“不要复苏”医嘱时患者的情况如下：15例ICU患者正在接受机械通气；15例中有14例（95%）正在接受强心剂治疗；15例患者中有12例（80%）正在接受麻醉性镇痛药治疗；1例（6%）患者正在接受透析。16例患者中有7例（44%）至少停用了一种治疗方式。16例中有13例（81%）的“不要复苏”医嘱是在与医生和家属进行记录在案的会诊后开具的。在这13例中，12例（92%）的讨论由医生发起。
儿科患者中，“不要复苏”医嘱在死亡的住院大龄儿童中比小龄儿童中开具得更频繁。大多数“不要复苏”医嘱是为在ICU中接受积极药物治疗的患者开具的。
