Daly B J, Gorecki J, Sadowski A, Rudy E B, Montenegro H D, Song R, Dyer M A
Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106-4904, USA.
Heart Lung. 1996 Jul-Aug;25(4):310-7. doi: 10.1016/s0147-9563(96)80067-7.
To determine the frequency of do-not-resuscitate (DNR) orders in the chronically critically ill; to identify the differences in clinical and demographic characteristics of chronically critically ill patients who have DNR orders and those who do not; to identify the differences in the cost of care between patients with and without DNR orders; and to identify the differences in DNR practices between an experimental special care unit and the traditional intensive care unit (ICU).
Randomized, prospective design with a block randomization scheme.
Two hundred twenty patients who met the following eligibility criteria for enrollment in a parent study of the special care unit: an ICU stay of at least 5 days, an absence of pulmonary artery monitoring, an absence of frequent titration of intravenous vasopressors, an Acute Physiology and Chronic Health Evaluation II score of less than 18, and a Therapeutic Intervention Scoring System score of less than 39.
A large, urban academic medical center.
Clinical and demographic variables describing the study populations, mental status, and timing of DNR orders, mortality rates, and cost of hospitalization.
There was no difference in the frequency of DNR orders between the special care unit versus the intensive care unit--although patients in the special care unit had a longer interval between hospital admission and initiation of the DNR order. DNR patients differed from non-DNR in that they were older, less likely to be married, and had a higher Acute Physiology and Chronic Health Evaluation II score on admission to the study. The mortality rate in the DNR group was 71% versus 6% in the non-DNR group. There was no difference in total costs. DNR patients were also more likely to have an impaired mental status on admission, and more likely to have deterioration in mental status by the time of discharge than the non-DNR patients.
确定慢性危重症患者中“不要复苏”（DNR）医嘱的频率；识别有DNR医嘱和无DNR医嘱的慢性危重症患者在临床和人口统计学特征上的差异；识别有和无DNR医嘱患者之间的护理费用差异；识别实验性特殊护理单元与传统重症监护病房（ICU）在DNR实践方面的差异。
采用区组随机化方案的随机前瞻性设计。
220名符合以下入选标准的患者，入选一项特殊护理单元母研究：在ICU住院至少5天，未进行肺动脉监测，未频繁滴定静脉血管加压药，急性生理与慢性健康状况评分系统II（APACHE II）评分低于18分，治疗干预评分系统（TISS）评分低于39分。
一家大型城市学术医疗中心。
描述研究人群的临床和人口统计学变量、精神状态、DNR医嘱的时间、死亡率和住院费用。
特殊护理单元与重症监护病房之间DNR医嘱的频率没有差异——尽管特殊护理单元的患者从入院到开始下达DNR医嘱的间隔时间更长。有DNR医嘱的患者与无DNR医嘱的患者不同之处在于，他们年龄更大，结婚的可能性更小，在进入研究时急性生理与慢性健康状况评分系统II评分更高。DNR组的死亡率为71%，而非DNR组为6%。总费用没有差异。与无DNR医嘱的患者相比，有DNR医嘱的患者入院时精神状态受损的可能性也更大，出院时精神状态恶化的可能性也更大。
