CURRENT Essentials of Critical Care.pdf

32 Current Essentials of Critical Care■■Do-Not-Resuscitate Orders (DNR)Essential Concepts• The Do-Not-Resuscitate (Do-Not-Attempt Resuscitation; DNR)order stops automatic cardiopulmonary resuscitation• Only applies to patient at time of cardiopulmonary arrest; withholdingor withdrawing other care separate decisions• DNR extends patient’s autonomy to make informed choice,while knowing consequences of decision• In multiple organ failure or critical illness, cardiopulmonary resuscitation 10% likelihood of success and very poor outcome(5% normal function)• Resuscitation of acute, reversible, witnessed arrest often moresuccessfulEssentials of Management• Consider DNR discussion with patient or other decision makerfor all critically ill patients in ICU• Determine if DNR already addressed in advance directives• Assure patient and family that DNR does not discontinue comfortmeasures and pain control• Follow institution’s DNR policy for documentation; includetime of discussion, persons who participated, level of understandingof patient, other decisions about patient care• If disagreement about DNR, make efforts to clarify misunderstandings,misconceptions, concerns• DNR may be temporarily suspended for general anesthesia orcardiac catheterization, during which there is increased risk ofcardiopulmonary arrest■ PearlOnly about 30% of patients with likely very poor outcome have DNRorders.ReferenceBurns JP et al: Do-not-resuscitate order after 25 years. Crit Care Med2003;31:1543. [PMID: 12771631]