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End-of-Life Care


Monday, October 25, 2004

10:30 AM- 12:00 PM

Should elderly patients with a DNR order be subjected to intubation and mechanical ventilation for acute respiratory failure?

Mohamed I. Ali, MD*, Scott M. Reminick, MD, FCCP, S. Naik, MD, FCCP, A. Mercado, MD, S. Khaleed, MD, M. Hernandez, MD and M. Mustafa, MD

The Brooklyn Hospital Center, Staten Island, NY

PURPOSE: In some hospitals, a "do not intubate" order (DNI) goes hand in hand with a "do not resuscitate" order (DNR). This is not the policy at the Brooklyn Hospital Center, where DNI is not implied with the DNR order and must be determined independently. We decided to evaluate the outcomes of patients with a DNR order who were subjected to intubation and mechanical ventilation for acute respiratory failure.

METHODS: A retrospective study was done of patients 70 years or older who were hospitalized for acute respiratory failure warranting mechanical ventilation. The group of patients with a DNR order at the time of presentation was compared to those without a DNR order in respect to the outcome.

RESULTS: 26 patients carried DNR orders while 35 did not. Patients who carried a DNR were older (87.15 + 6.39 years vs. 82.6 + 7.71 years [mean + SD]; p < 0.5). In-hospital mortality for patients who carried a DNR order exceeded that for patients without a DNR order (69.3% vs. 48.6%), however the difference was statistically not significant.

CONCLUSION: A DNR order is not an independent risk factor for death for those patients who required intubation and mechanical ventilation for acute respiratory failure. Physicians should not assume that a patient with a DNR order will not benefit from mechanical ventilation for acute respiratory failure.

CLINICAL IMPLICATIONS: Each DNR order need not be accompanied by a DNI unless specifically requested by the patient or their health care proxy. More education and media awareness may assist the patients and their surrogate in making their decision.

DISCLOSURE: M.I. Ali, None.






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