Journal article
Do-not-intubate orders in patients with acute respiratory failure: a systematic review and meta-analysis
Intensive care medicine, Vol.46(1), pp.36-45
01/01/2020
DOI: 10.1007/s00134-019-05828-2
PMCID: PMC7223954
PMID: 31659387
Abstract
To assess the rates and variability of do-not-intubate orders in patients with acute respiratory failure.
We conducted a systematic review of observational studies that enrolled adult patients with acute respiratory failure requiring noninvasive ventilation or high-flow nasal cannula oxygen from inception to 2019.
Twenty-six studies evaluating 10,755 patients were included. The overall pooled rate of do-not-intubate orders was 27%. The pooled rate of do-not-intubate orders in studies from North America was 14% (range 9-22%), from Europe was 28% (range 13-58%), and from Asia was 38% (range 9-83%), p = 0.001. Do-not-intubate rates were higher in studies with higher patient age and in studies where do-not-intubate decisions were made without reported patient/family input. There were no significant differences in do-not-intubate orders according to illness severity, observed mortality, malignancy comorbidity, or methodological quality. Rates of do-not-intubate orders increased over time from 9% in 2000-2004 to 32% in 2015-2019. Only 12 studies (46%) reported information about do-not-intubate decision-making processes. Only 4 studies (15%) also reported rates of do-not-resuscitate.
One in four patients with acute respiratory failure (who receive noninvasive ventilation or high-flow nasal cannula oxygen) has a do-not-intubate order. The rate of do-not-intubate orders has increased over time. There is high inter-study variability in do-not-intubate rates-even when accounting for age and illness severity. There is high variability in patient/family involvement in do-not-intubate decision making processes. Few studies reported differences in rates of do-not-resuscitate and do-not-intubate-even though recovery is very different for acute respiratory failure and cardiac arrest.
Details
- Title: Subtitle
- Do-not-intubate orders in patients with acute respiratory failure: a systematic review and meta-analysis
- Creators
- Michael E Wilson - Mayo ClinicAniket Mittal - Mayo ClinicBibek Karki - Mayo ClinicClaudia C Dobler - Mayo Clinic in ArizonaAbdul Wahab - Mayo ClinicJ Randall Curtis - Harborview Medical CenterPatricia J Erwin - Mayo Clinic in FloridaAbdul M Majzoub - Mayo Clinic in ArizonaVictor M Montori - Mayo Clinic in FloridaOgnjen Gajic - Mayo ClinicM Hassan Murad - Mayo Clinic
- Resource Type
- Journal article
- Publication Details
- Intensive care medicine, Vol.46(1), pp.36-45
- DOI
- 10.1007/s00134-019-05828-2
- PMID
- 31659387
- PMCID
- PMC7223954
- ISSN
- 0342-4642
- eISSN
- 1432-1238
- Language
- English
- Date published
- 01/01/2020
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984691512502771
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