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28.10.2019 | Original

Do-not-intubate orders in patients with acute respiratory failure: a systematic review and meta-analysis

verfasst von: Michael E. Wilson, Aniket Mittal, Bibek Karki, Claudia C. Dobler, Abdul Wahab, J. Randall Curtis, Patricia J. Erwin, Abdul M. Majzoub, Victor M. Montori, Ognjen Gajic, M. Hassan Murad

Erschienen in: Intensive Care Medicine | Ausgabe 1/2020

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Abstract

Purpose

To assess the rates and variability of do-not-intubate orders in patients with acute respiratory failure.

Methods

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.

Results

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.

Conclusions

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.

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Titel: Do-not-intubate orders in patients with acute respiratory failure: a systematic review and meta-analysis
verfasst von: Michael E. Wilson
Aniket Mittal
Bibek Karki
Claudia C. Dobler
Abdul Wahab
J. Randall Curtis
Patricia J. Erwin
Abdul M. Majzoub
Victor M. Montori
Ognjen Gajic
M. Hassan Murad
Publikationsdatum: 28.10.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 1/2020
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-019-05828-2

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