Early versus late DNR orders and its predictors in a Saudi Arabian ICU: A descriptive study
Background: Practices of Do-Not-Resuscitate (DNR) orders show discrepancies worldwide, but there are only few such studies from Saudi Arabia. Objective: To describe the practice of DNR orders in a Saudi Arabian tertiary care ICU. Methods: This retrospective study included all patients who died with...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | Saudi Journal of Medicine and Medical Sciences |
| Subjects: | |
| Online Access: | http://www.sjmms.net/article.asp?issn=1658-631X;year=2022;volume=10;issue=3;spage=192;epage=197;aulast=Aletreby |
| _version_ | 1798020257002029056 |
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| author | Waleed Tharwat Aletreby Ahmed F Mady Mohammed A Al-Odat Ahmed N Balshi Anas A Mady Adam M Al-Odat Amira M Elshayeb Ahmed F Mostafa Shereen A Abd Elsalam Kriz L Odchigue |
| author_facet | Waleed Tharwat Aletreby Ahmed F Mady Mohammed A Al-Odat Ahmed N Balshi Anas A Mady Adam M Al-Odat Amira M Elshayeb Ahmed F Mostafa Shereen A Abd Elsalam Kriz L Odchigue |
| author_sort | Waleed Tharwat Aletreby |
| collection | DOAJ |
| description | Background: Practices of Do-Not-Resuscitate (DNR) orders show discrepancies worldwide, but there are only few such studies from Saudi Arabia.
Objective: To describe the practice of DNR orders in a Saudi Arabian tertiary care ICU.
Methods: This retrospective study included all patients who died with a DNR order at the ICU of King Saud Medical City, Riyadh, Saudi Arabia, between January 1 to December 31, 2021. The percentage of early DNR (i.e., ≤48 hours of ICU admission) and late DNR (>48 hours) orders were determined and the variables between the two groups were compared. The determinants of late DNR were also investigated.
Results: A total of 723 cases met the inclusion criteria, representing 14.9% of all ICU discharges and 63% of all ICU deaths during the study period. The late DNR group comprised the majority of the cases (78.3%), and included significantly more patients with acute respiratory distress syndrome (ARDS), community acquired pneumonia (CAP), acute kidney injury, and COVID-19, and significantly fewer cases of readmissions and malignancies. Septic shock lowered the odds of a late DNR (OR = 0.4, 95% CI: 0.2–0.9; P = 0.02), while ARDS (OR = 3.3, 95% CI: 2–5.4; P < 0.001), ischemic stroke (OR = 2.5, 95% CI: 1.1–5.4; P = 0.02), and CAP (OR = 2, 95% CI: 1.3–3.1; P = 0.003) increased the odds of a late DNR.
Conclusion: There was a higher frequency of late DNR orders in our study compared to those reported in several studies worldwide. Cases with potential for a favorable outcome were more likely to have a late DNR order, while those with expected poorer outcomes were more likely to have an early DNR order. The discrepancies highlight the need for clearer guidelines to achieve consistency. |
| first_indexed | 2024-04-11T16:54:54Z |
| format | Article |
| id | doaj.art-80f739101e66406b806cbb79498a7250 |
| institution | Directory Open Access Journal |
| issn | 1658-631X |
| language | English |
| last_indexed | 2024-04-11T16:54:54Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Saudi Journal of Medicine and Medical Sciences |
| spelling | doaj.art-80f739101e66406b806cbb79498a72502022-12-22T04:13:18ZengWolters Kluwer Medknow PublicationsSaudi Journal of Medicine and Medical Sciences1658-631X2022-01-0110319219710.4103/sjmms.sjmms_141_22Early versus late DNR orders and its predictors in a Saudi Arabian ICU: A descriptive studyWaleed Tharwat AletrebyAhmed F MadyMohammed A Al-OdatAhmed N BalshiAnas A MadyAdam M Al-OdatAmira M ElshayebAhmed F MostafaShereen A Abd ElsalamKriz L OdchigueBackground: Practices of Do-Not-Resuscitate (DNR) orders show discrepancies worldwide, but there are only few such studies from Saudi Arabia. Objective: To describe the practice of DNR orders in a Saudi Arabian tertiary care ICU. Methods: This retrospective study included all patients who died with a DNR order at the ICU of King Saud Medical City, Riyadh, Saudi Arabia, between January 1 to December 31, 2021. The percentage of early DNR (i.e., ≤48 hours of ICU admission) and late DNR (>48 hours) orders were determined and the variables between the two groups were compared. The determinants of late DNR were also investigated. Results: A total of 723 cases met the inclusion criteria, representing 14.9% of all ICU discharges and 63% of all ICU deaths during the study period. The late DNR group comprised the majority of the cases (78.3%), and included significantly more patients with acute respiratory distress syndrome (ARDS), community acquired pneumonia (CAP), acute kidney injury, and COVID-19, and significantly fewer cases of readmissions and malignancies. Septic shock lowered the odds of a late DNR (OR = 0.4, 95% CI: 0.2–0.9; P = 0.02), while ARDS (OR = 3.3, 95% CI: 2–5.4; P < 0.001), ischemic stroke (OR = 2.5, 95% CI: 1.1–5.4; P = 0.02), and CAP (OR = 2, 95% CI: 1.3–3.1; P = 0.003) increased the odds of a late DNR. Conclusion: There was a higher frequency of late DNR orders in our study compared to those reported in several studies worldwide. Cases with potential for a favorable outcome were more likely to have a late DNR order, while those with expected poorer outcomes were more likely to have an early DNR order. The discrepancies highlight the need for clearer guidelines to achieve consistency.http://www.sjmms.net/article.asp?issn=1658-631X;year=2022;volume=10;issue=3;spage=192;epage=197;aulast=Aletrebydo-not-resuscitatefrequencyintensive care unitresuscitation orderssaudi arabiatiming |
| spellingShingle | Waleed Tharwat Aletreby Ahmed F Mady Mohammed A Al-Odat Ahmed N Balshi Anas A Mady Adam M Al-Odat Amira M Elshayeb Ahmed F Mostafa Shereen A Abd Elsalam Kriz L Odchigue Early versus late DNR orders and its predictors in a Saudi Arabian ICU: A descriptive study Saudi Journal of Medicine and Medical Sciences do-not-resuscitate frequency intensive care unit resuscitation orders saudi arabia timing |
| title | Early versus late DNR orders and its predictors in a Saudi Arabian ICU: A descriptive study |
| title_full | Early versus late DNR orders and its predictors in a Saudi Arabian ICU: A descriptive study |
| title_fullStr | Early versus late DNR orders and its predictors in a Saudi Arabian ICU: A descriptive study |
| title_full_unstemmed | Early versus late DNR orders and its predictors in a Saudi Arabian ICU: A descriptive study |
| title_short | Early versus late DNR orders and its predictors in a Saudi Arabian ICU: A descriptive study |
| title_sort | early versus late dnr orders and its predictors in a saudi arabian icu a descriptive study |
| topic | do-not-resuscitate frequency intensive care unit resuscitation orders saudi arabia timing |
| url | http://www.sjmms.net/article.asp?issn=1658-631X;year=2022;volume=10;issue=3;spage=192;epage=197;aulast=Aletreby |
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