You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT JAMA
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 255 No. 3, January 17, 1986 TABLE OF CONTENTS
  JAMA
  •  Online Features
  ARTICLE
 This Article
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Contact me when this article is cited
 Related Content
 •Similar articles in JAMA

The use and implications of do not resuscitate orders in intensive care units

J. E. Zimmerman, W. A. Knaus, S. M. Sharpe, A. S. Anderson, E. A. Draper and D. P. Wagner

To describe current "do not resuscitate" (DNR) order writing practices, we studied 7,265 intensive care unit (ICU) admissions at 13 hospitals. All of the ICUs used DNR orders and 39% of all in-unit deaths were preceded by them. Patients with DNR orders were often elderly and in severely failing health. They were more severely ill than other patients in ICUs, and often had multiple organ failure. Most patients with DNR orders (94%) died in the hospital, and 86% died or were discharged from the ICU three days after a DNR order. The frequency of DNR orders ranged from 0.4% to 13.5%, and the mean interval from ICU admission to DNR order was from 5.4 to 24 days. These variations could not be explained by differences in patient characteristics, and may reflect varying physician attitudes. Do not resuscitate orders are now an accepted practice in ICUs and their use follows basic ethical and scientific guidelines. The brief interval between writing a DNR order and death or ICU discharge suggests that they often represent a decision point for placing broader limits on therapy.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The do-not-resuscitate order: associations with advance directives, physician specialty and documentation of discussion 15 years after the Patient Self-Determination Act
Morrell et al.
J. Med. Ethics 2008;34:642-647.
ABSTRACT | FULL TEXT  

Integrating Palliative and Critical Care: Evaluation of a Quality-Improvement Intervention
Curtis et al.
Am. J. Respir. Crit. Care Med. 2008;178:269-275.
ABSTRACT | FULL TEXT  

The withholding of truth when counselling relatives of the critically ill: a rational defence
Berry
Clin Ethics 2008;3:42-45.
ABSTRACT | FULL TEXT  

DNR directives are established early in mechanically ventilated intensive care unit patients: [Les directives PDR sont etablies tot chez les patients sous ventilation mecanique a l'unite des soins intensifs]
Sinuff et al.
Canadian J. Anesthesia 2004;51:1034-1041.
ABSTRACT | FULL TEXT  

Do-Not-Resuscitate Orders in Patients Hospitalized With Acute Myocardial Infarction: The Worcester Heart Attack Study
Jackson et al.
Arch Intern Med 2004;164:776-783.
ABSTRACT | FULL TEXT  

Impact of a Proactive Approach to Improve End-of-Life Care in a Medical ICU
Campbell and Guzman
Chest 2003;123:266-271.
ABSTRACT | FULL TEXT  

Rationing intensive care
Bion
BMJ 1995;310:682-683.
FULL TEXT  

Prognosis for Recovery from Multiple Organ system failure: The Accuracy of Objective Estimates of Chances for Survival
Rauss et al.
Med Decis Making 1990;10:155-162.
ABSTRACT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 1986 American Medical Association. All Rights Reserved.