Abstract

Objective: To investigate the characteristics, outcomes, and follow-up of geriatric patients with do-not-resuscitate (DNR) orders after receiving non-invasive ventilation (NIV) in the emergency room (ER) and to evaluate the feasibility of caring for these patients in general medical wards.

Patients and methods: This retrospective study was conducted from January 2017 to December 2019. Of 1841 patients whowere diagnosed with acute respiratory failure (ARF) in our ER, 147 received NIV as a salvage treatment. Among them, 121 patients (81 patients with DNR) who were older than 65 years and admitted to general medical wards for further care were included in this study.

Results: Patients with DNR orders were older (83.5 ± 0.9 years vs. 77.6 ± 1.3 years, p < 0.01) and had lower coma scale scores (10.7 ± 0.5 vs. 13.5 ± 0.5, p < 0.01), higher APACHE II scores (23.9 ± 0.8 vs. 20.7 ± 0.9, p = 0.01), and higher comorbidity scores (7.3 ± 0.2 vs. 6.5 ± 0.4, p = 0.03) than those without DNR orders. However, there were no differences in the causes of ARF between patients with and without DNR orders (p = 0.74). Patients with DNR orders had worse weaning outcomes (64.2% vs. 90%, p < 0.01) and hospital survival rate (61.7% vs. 90%, p < 0.01) than those without DNR orders. At 180 days after hospital discharge, 61.3% patients in the DNR group and 86.7% patients in the no DNR group were still alive (p < 0.01).

Conclusion: Patients with DNR orders were older and had more severe diseases, higher comorbidity, less consciousness, and worseweaning outcomes and hospital survival than those without DNR orders. Patients with DNR orders had a dismal prognosis even after hospital discharge.