title: Do-not-resuscitate orders in the critically ill patient--an observational study with special emphasis on withholding of renal replacement therapy.
abstract: We examined the process, consequences and impact of writing a Do-Not-Resuscitate (DNR) order in a cohort of critically-ill ICU patients. Special emphasis was given to the DNR order including withholding renal replacement therapy. A DNR code was mainly written in the first week following ICU admission and more often given to medical, older and sicker patients. Patients never actively participated in the decision and in only half of the cases the DNR order was discussed with relatives. Mortality of all patients studied was 21% of whom 67% died with a DNR order. In our population, the final in-hospital mortality rate of DNR-coded patients was 100%, because the DNR status was ordered when the patients were already very sick. DNR-coded patients died after a longer mean length of ICU stay than patients without a code. Withholding renal replacement therapy was commonly added to the DNR order even if renal failure either was not present or never developed.
authors.affiliation: Dienst Intensieve Geneeskunde, Universitair Ziekenhuis, Vrije Universiteit Brussel, Belgium. k.janssenvandoorn@gmail.com
authors.forename: K
authors.initials: K
authors.lastname: Janssen van Doorn
authors.forename: M
authors.initials: M
authors.lastname: Diltoer
authors.forename: H
authors.initials: H
authors.lastname: Spapen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003422:Critical Care; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data*; D016414:Resuscitation Orders; D012189:Retrospective Studies; D028761:Withholding Treatment / Q000706:statistics & numerical data*