Early and late do-not-resuscitate (DNR) decisions in patients with terminal COPD: a retrospective study in the last year of life

International Journal of Chronic Obstructive Pulmonary Disease
Pin-Kuei FuDuan-Rung Chen

Abstract

The unpredictable trajectory of COPD can present challenges for patients when faced with a decision regarding a do-not-resuscitate (DNR) directive. The current retrospective analysis was conducted to investigate factors associated with an early DNR decision (prior to last hospital admission) and differences in care patterns between patients who made DNR directives early vs late. Electronic health records (EHR) were reviewed from 271 patients with terminal COPD who died in a teaching hospital in Taiwan. Clinical parameters, patterns of DNR decisions, and medical utilization were obtained. Those patients who had a DNR directive earlier than their last (terminal) admission were defined as "Early DNR" (EDNR). A total of 234 (86.3%) patients died with a DNR directive, however only 30% were EDNR. EDNR was associated with increased age (OR=1.07; 95% CI: 1.02-1.12), increased ER visits (OR=1.22; 95% CI: 1.10-1.37), rapid decline in lung function (OR=3.42; 95% CI: 1.12-10.48), resting heart rate ≥100 (OR=3.02; 95% CI: 1.07-8.51), and right-sided heart failure (OR=2.38; 95% CI: 1.10-5.19). The median time period from a DNR directive to death was 68.5 days in EDNR patients and 5 days in "Late DNR" (LDNR) patients, respectively (P<0.001). ...Continue Reading

Citations

Dec 18, 2020·Current Opinion in Pulmonary Medicine·Brian Allen, Loutfi S Aboussouan
Jun 1, 2021·Frontiers in Public Health·Hala SultanMaysa Al-Hussaini
Jun 8, 2021·Notfall & Rettungsmedizin·Spyros D MentzelopoulosLeo Bossaert

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