한 내과계 중환자실에서 사망한 환자들의 심폐소생술 거절 현황
Do-not-resuscitate Order in Patients, Who Were Deceased in a Medical Intensive Care Unit of an University Hospital in Korea
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초록
Background: Do-not-resuscitate (DNR) in the event of a cardiac arrest is the most common and important discussion between a patient`s family and physicians among the end-of-life decision-making process. To observe the performance of a DNR order in critically ill patients, we analyzed the incidence of DNR orders, the changes in therapeutic levels after DNR orders, and the cases of violated DNR codes in patients who had died in a Korean medical intensive care unit (ICU) between 1 January 2006 and 30 June 2006. Methods: The charts of patients who had died in the medical ICU were retrospectively reviewed. Results: One hundred two patients were enrolled. The ICU and hospital lengths of stay of the patients were 12.4 ± 14.0 and 23.2 ± 21.1 days, respectively. Hematologic malignancy (24.5%) accounted for the most common premorbid diagnosis before ICU admission. Seventy-five patients (73.5%) had DNR orders. The DNR order was suggested by the physician in 96% of the patients. There was no significant difference in the clinical parameters and the performance of a DNR order. Eighty-four percent of the patients with a DNR order had received the order within 3 days death. The withholding of additional therapy or withdrawing of current therapy occurred in 57.3% of the patients. The DNR order was violated in 9 cases (12%). Conclusions: DNR orders are well-accepted by the patient`s family in the ICU. However, DNR orders are initiated when patient death is imminent.
Abstract
Background: Do-not-resuscitate (DNR) in the event of a cardiac arrest is the most common and important discussion between a patient`s family and physicians among the end-of-life decision-making process. To observe the performance of a DNR order in critically ill patients, we analyzed the incidence of DNR orders, the changes in therapeutic levels after DNR orders, and the cases of violated DNR codes in patients who had died in a Korean medical intensive care unit (ICU) between 1 January 2006 and 30 June 2006. Methods: The charts of patients who had died in the medical ICU were retrospectively reviewed. Results: One hundred two patients were enrolled. The ICU and hospital lengths of stay of the patients were 12.4 ± 14.0 and 23.2 ± 21.1 days, respectively. Hematologic malignancy (24.5%) accounted for the most common premorbid diagnosis before ICU admission. Seventy-five patients (73.5%) had DNR orders. The DNR order was suggested by the physician in 96% of the patients. There was no significant difference in the clinical parameters and the performance of a DNR order. Eighty-four percent of the patients with a DNR order had received the order within 3 days death. The withholding of additional therapy or withdrawing of current therapy occurred in 57.3% of the patients. The DNR order was violated in 9 cases (12%). Conclusions: DNR orders are well-accepted by the patient`s family in the ICU. However, DNR orders are initiated when patient death is imminent.
참고문헌 (24)
- Stevens MB, "Withholding resuscitation", Am Fam Physician, 33, pp.207~212 (1986)
- "AAFP approves policy on life-sustaining treatment", Am Fam Physician, 41, pp.330~332 (1990)
- "Ethical issues in the management of the demented patient. The American Academy of Neurology Ethics and Humanities Subcommittee", Neurology, 46, pp.1180~1183 (1996)
- King SB 3rd, "Task force 2: application of medical and surgical interventions near the end of life", J Am Coll Cardiol, 31, pp.933~942 (1998)
- Ethics manual, "Fourth edition. American College of Physicians", Ann Intern Med, 128, pp.576~594 (1998)
- "Making treatment decisions for incapacitated older adults without advance directives. AGS Ethics Committee. American Geriatrics Society", J Am Geriatr Soc, 44, pp.986~987 (1996)
- "Guidelines for cardiopulmonary resuscitation and emergency cardiac care. Emergency Cardiac Care Committee and Subcommittees, American Heart Association. Part VIII. Ethical considerations in resuscitation", JAMA, 268, pp.2282~2288 (1992)
- "American Thoracic Society: Withholding and withdrawing life-sustaining therapy", Ann Intern Med, 115, pp.478~485 (1991)
- Cantor MD, "Do-not-resuscitate orders and medical futility", Arch Intern Med, 163, pp.2689~2694 (2003)
- Shepardson LB, "Variation in the use of do-not-resuscitate orders in patients with stroke", Arch Intern Med, 157, pp.1841~1847 (1997)
- Phillips RS, "Choices of seriously ill patients about cardiopulmonary resuscitation: correlates and outcomes. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments", Am J Med, 100, pp.128~137 (1996)
- Wenger NS, "Epidemiology of do-not-resuscitate orders. Disparity by age, diagnosis, gender, race, and functional impairment", Arch Intern Med, 155, pp.2056~2062 (1995)
- "Ethical and moral guidelines for the initiation, continuation, and withdrawal of intensive care. American College of Chest Physicians", Society of Critical Care Medicine Consensus Panel, 1990, pp.97, 949~958
- AMA policy, "covenants not to compete are unethical for physicians in training. Council on Ethical and Judicial Affairs, American Medical Association", JAMA, 278, pp.530an~ (1997)
- Burns JP, "Do-not-resuscitate order after 25 years", Crit Care Med, 31, pp.1543~1550 (2003)
- Song T, "Factors determining the establishment of DNR orders in oncologic patients at a university hospital in Korea", Korean J Med, 74, pp.403~410 (2008)
- Kim do Y, "Do-not-resuscitate orders for terminal patients with cancer in teaching hospitals of Korea", J Palliat Med, 10, pp.1153~1158 (2007)
- Knaus WA, "APACHE II: a severity of disease classification system", Crit Care Med, 13, pp.818~829 (1985)
- Vincent JL, "The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction", failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine, 1996, pp.22, 707~710
- Ruark JE, "Initiating and withdrawing life support. Principles and practice in adult medicine", N Engl J Med, 318, pp.25~30 (1988)
- Luce JM, "Withholding and withdrawal of life support from critically ill patients", Chest, 94, pp.621~626 (1988)
- Chung SP, "A retrospective review of the Do-Not-Resuscitate patients", J Korean Soc Emerg Med, 9, pp.271~276 (1998)
- Prendergast TJ, "A national survey of end-of-life care for critically ill patients", Am J Respir Crit Care Med, 158, pp.1163~1167 (1998)
- Koh Y, "The first report of Korean Academy of Medical sciences on the medical ethics guideline for withholding and withdrawing of life-sustaining therapies in terminal patients", Korean Academy of Medical Sciences, pp.102~109 (2002)