PDF(Pubmed)
Abstract：
UNASSIGNED: As patient life expectancy has increased and people are living longer than before, the rate of mechanical ventilation among elderly patients in the intensive care unit has increased. Older patients who receive mechanical ventilation and have multiple comorbidities are more likely to have a do not resuscitate order than are younger patients with fewer comorbidities. The aim of our study was to describe the patient characteristics and predictive factors of do not resuscitate orders during hospitalization among elderly patients who received ventilation in the intensive care unit.
UNASSIGNED: This was a retrospective review of the electronic medical records of patients in the intensive care unit of a teaching hospital in southern Taiwan. We enrolled patients admitted to the general intensive care unit from January 1, 2018, to September 31, 2020, and patients older than 80 years who experienced respiratory failure, were intubated and received mechanical ventilation. We analyzed patient demographics, disease severity during hospitalization and comorbidities. If a patient had multiple admissions to the intensive care unit, only the first admission was recorded.
UNASSIGNED: Of the 305 patients over 80 years of age with respiratory failure who were intubated and placed on a ventilator, 66 were excluded because of incomplete data, and 13 were excluded because they had already signed a do not resuscitate order prior to admission to the hospital. Ultimately, 226 patients were included in this study. A higher acute physiology and chronic health evaluation II score (>30) was also associated with an increased likelihood of a do not resuscitate order (odds ratio (OR) = 3.85, 95% CI = 1.09-13.62, p = 0.0362). Patients who had acute kidney injury or cerebrovascular accident were more likely to have a do not resuscitate order (OR = 2.74, 95% CI = 1.03-7.28, p = 0.0428 and OR = 7.32, 95% CI = 2.02-26.49, p = 0.0024, respectively).
UNASSIGNED: Our study showed that older age, greater disease severity, and certain critical interventions were associated with a greater propensity for do not resuscitate orders, which is crucial for understanding patient preferences and guiding end-of-life care discussions. These findings highlight the importance of clinical severity and specific health events in predicting end-of-life care preferences in older patient groups.
UNASSIGNED: This was a retrospective review of the electronic medical records of patients in the intensive care unit of a teaching hospital in southern Taiwan. We enrolled patients admitted to the general intensive care unit from January 1, 2018, to September 31, 2020, and patients older than 80 years who experienced respiratory failure, were intubated and received mechanical ventilation. We analyzed patient demographics, disease severity during hospitalization and comorbidities. If a patient had multiple admissions to the intensive care unit, only the first admission was recorded.
UNASSIGNED: Of the 305 patients over 80 years of age with respiratory failure who were intubated and placed on a ventilator, 66 were excluded because of incomplete data, and 13 were excluded because they had already signed a do not resuscitate order prior to admission to the hospital. Ultimately, 226 patients were included in this study. A higher acute physiology and chronic health evaluation II score (>30) was also associated with an increased likelihood of a do not resuscitate order (odds ratio (OR) = 3.85, 95% CI = 1.09-13.62, p = 0.0362). Patients who had acute kidney injury or cerebrovascular accident were more likely to have a do not resuscitate order (OR = 2.74, 95% CI = 1.03-7.28, p = 0.0428 and OR = 7.32, 95% CI = 2.02-26.49, p = 0.0024, respectively).
UNASSIGNED: Our study showed that older age, greater disease severity, and certain critical interventions were associated with a greater propensity for do not resuscitate orders, which is crucial for understanding patient preferences and guiding end-of-life care discussions. These findings highlight the importance of clinical severity and specific health events in predicting end-of-life care preferences in older patient groups.
摘要：
■随着患者预期寿命的增加，人们的寿命比以前更长，重症监护病房老年患者的机械通气率有所增加。接受机械通气并有多种合并症的老年患者比具有较少合并症的年轻患者更有可能出现不复苏顺序。我们研究的目的是描述在重症监护病房接受通气的老年患者住院期间不复苏医嘱的患者特征和预测因素。
■这是对台湾南部一家教学医院重症监护病房患者的电子病历的回顾性回顾。我们招募了2018年1月1日至2020年9月31日入住普通重症监护病房的患者，以及80岁以上出现呼吸衰竭的患者。插管并接受机械通气。我们分析了病人的人口统计,住院期间的疾病严重程度和合并症。如果一个病人多次进入重症监护室，只有第一次入院记录。
■在305名80岁以上的呼吸衰竭患者中，66个由于数据不完整而被排除在外，13人被排除在外，因为他们在入院前已经签署了不复苏令。最终,226名患者被纳入本研究。较高的急性生理学和慢性健康评估II评分（>30）也与不复苏顺序的可能性增加相关（比值比（OR）=3.85，95％CI=1.09-13.62，p=0.0362）。发生急性肾损伤或脑血管意外的患者更有可能出现不复苏顺序（分别为OR=2.74，95％CI=1.03-7.28，p=0.0428和OR=7.32，95％CI=2.02-26.49，p=0.0024）。
■我们的研究表明，年龄较大，更严重的疾病，某些关键干预措施与更大的不复苏倾向相关，这对于了解患者的偏好和指导临终护理讨论至关重要。这些发现强调了临床严重程度和特定健康事件在预测老年患者组临终关怀偏好方面的重要性。
■这是对台湾南部一家教学医院重症监护病房患者的电子病历的回顾性回顾。我们招募了2018年1月1日至2020年9月31日入住普通重症监护病房的患者，以及80岁以上出现呼吸衰竭的患者。插管并接受机械通气。我们分析了病人的人口统计,住院期间的疾病严重程度和合并症。如果一个病人多次进入重症监护室，只有第一次入院记录。
■在305名80岁以上的呼吸衰竭患者中，66个由于数据不完整而被排除在外，13人被排除在外，因为他们在入院前已经签署了不复苏令。最终,226名患者被纳入本研究。较高的急性生理学和慢性健康评估II评分（>30）也与不复苏顺序的可能性增加相关（比值比（OR）=3.85，95％CI=1.09-13.62，p=0.0362）。发生急性肾损伤或脑血管意外的患者更有可能出现不复苏顺序（分别为OR=2.74，95％CI=1.03-7.28，p=0.0428和OR=7.32，95％CI=2.02-26.49，p=0.0024）。
■我们的研究表明，年龄较大，更严重的疾病，某些关键干预措施与更大的不复苏倾向相关，这对于了解患者的偏好和指导临终护理讨论至关重要。这些发现强调了临床严重程度和特定健康事件在预测老年患者组临终关怀偏好方面的重要性。
