Saudi Journal of Medicine and Medical Sciences

ORIGINAL ARTICLE
Year
: 2022  |  Volume : 10  |  Issue : 3  |  Page : 192--197

Early versus late DNR orders and its predictors in a Saudi Arabian ICU: A descriptive study


Waleed Tharwat Aletreby1, Ahmed F Mady2, Mohammed A Al-Odat1, Ahmed N Balshi1, Anas A Mady3, Adam M Al-Odat4, Amira M Elshayeb1, Ahmed F Mostafa1, Shereen A Abd Elsalam5, Kriz L Odchigue6 
1 Department of Critical Care, King Saud Medical City, Riyadh, Saudi Arabia
2 Department of Critical Care, King Saud Medical City, Riyadh, Saudi Arabia; Department of Anesthesia, Faculty of Medicine, Tanta University, Tanta, Egypt
3 Department of College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia
4 College of Medicine, Jordanian University of Science and Technology, Amman, Jordan
5 Department of Internal Medicine, King Salman Hospital, Riyadh, Saudi Arabia; Department of Internal Medicine and Hematology, Faculty of Medicine, Tanta University, Tanta, Egypt
6 Department of Nursing, King Saud Medical City, Riyadh, Saudi Arabia

Correspondence Address:
Waleed Tharwat Aletreby
Department of Critical Care, King Saud Medical City, Riyadh
Saudi Arabia

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.


How to cite this article:
Aletreby WT, Mady AF, Al-Odat MA, Balshi AN, Mady AA, Al-Odat AM, Elshayeb AM, Mostafa AF, Abd Elsalam SA, Odchigue KL. Early versus late DNR orders and its predictors in a Saudi Arabian ICU: A descriptive study.Saudi J Med Med Sci 2022;10:192-197


How to cite this URL:
Aletreby WT, Mady AF, Al-Odat MA, Balshi AN, Mady AA, Al-Odat AM, Elshayeb AM, Mostafa AF, Abd Elsalam SA, Odchigue KL. Early versus late DNR orders and its predictors in a Saudi Arabian ICU: A descriptive study. Saudi J Med Med Sci [serial online] 2022 [cited 2022 Dec 4 ];10:192-197
Available from: https://www.sjmms.net/article.asp?issn=1658-631X;year=2022;volume=10;issue=3;spage=192;epage=197;aulast=Aletreby;type=0