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. 2022 Sep-Dec;10(3):192-197.
doi: 10.4103/sjmms.sjmms_141_22. Epub 2022 Aug 22.

Early Versus Late DNR Orders and its Predictors in a Saudi Arabian ICU: A Descriptive Study

Waleed Tharwat Aletreby  1 , Ahmed F Mady  1   2 , Mohammed A Al-Odat  1 , Ahmed N Balshi  1 , Anas A Mady  3 , Adam M Al-Odat  4 , Amira M Elshayeb  1 , Ahmed F Mostafa  1 , Shereen A Abd Elsalam  5   6 , Kriz L Odchigue  7
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Early Versus Late DNR Orders and its Predictors in a Saudi Arabian ICU: A Descriptive Study

Waleed Tharwat Aletreby et al. Saudi J Med Med Sci. 2022 Sep-Dec.

Abstract

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.

Keywords: Do-not-resuscitate; Saudi Arabia; frequency; intensive care unit; resuscitation orders; timing.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Patients' enrollment diagram
Figure 2
Figure 2
Percentage of diagnoses in late and early DNR groups: ARDS – Acute respiratory distress syndrome; CAP – Community acquired pneumonia; AKI – Acute kidney injury; MOF – Multi-organ failure; CPR – Cardiopulmonary resuscitation; PE – Pulmonary embolism; ESRD – End stage renal disease
See this image and copyright information in PMC

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References

    1. Flannery L, Ramjan LM, Peters K. End-of-life decisions in the Intensive Care Unit (ICU) – Exploring the experiences of ICU nurses and doctors – A critical literature review. Aust Crit Care. 2016;29:97–103. - PubMed
    1. Lin KH, Huang SC, Wang CH, Chau-Chung, Chu TS, Chen YY. Physician workload associated with do-not-resuscitate decision-making in Intensive Care Units: An observational study using Cox proportional hazards analysis. BMC Med Ethics. 2019;20:15. - PMC - PubMed
    1. Monteiro NF, Simões I, Gaspar I, Carmo E. Do-not-resuscitate and treatment limitation decisions – Six years of experience from a Portuguese general Intensive Care Unit. Rev Assoc Med Bras (1992) 2019;65:1168–73. - PubMed
    1. American Thoracic Society. Withholding and withdrawing life-sustaining therapy. Ann Intern Med. 1991;115:478–85. - PubMed
    1. Guidelines for the appropriate use of do-not-resuscitate orders. Council on Ethical and Judicial Affairs, American Medical Association. JAMA. 1991;265:1868–71. - PubMed