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Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Do-not-resuscitate orders, unintended consequences, and the ripple effect. | Available online http ccforum.eom content 11 2 121 Commentary Do-not-resuscitate orders unintended consequences and the ripple effect J Claude Hemphill III Department of Neurology Room 4M62 San Francisco General Hospital 1001 Potrero Avenue San Francisco CA 94110 USA Corresponding author J Claude Hemphill III chemphill@sfgh.ucsf.edu Published 2 March 2007 This article is online at http ccforum.com content 11 2 121 2007 BioMed Central Ltd Critical Care 2007 11 121 doi 10.1186 cc5687 Abstract Do-not-resuscitate DNR orders are commonly implemented in the critical care setting as a prelude to end-of-life care. This is often based on presumed prognosis for favorable outcome and interpretation of patient family and even physician wishes. While DNR orders explicitly apply only to an individual patient the hospital culture and milieu in which DNR orders are implemented could potentially have an overall impact on aggressiveness of care across patients. As illustrated by the example of intracerebral hemorrhage this may unexpectedly influence outcome even in patients without DNR orders in place. Improving end-of-life care in the critical care setting has justifiably become an increasing priority 1 . In patients with severe neurological impairment due to stroke head trauma hypoxic-ischemic brain injury after cardiac arrest and other conditions decisions to limit or withdraw care are often made based on perception of a poor prognosis for functional outcome. The decision to limit care however is predicated on the assumption that the prognosis is known and accurate. The possibilities that prognostic inaccuracy early after stroke and head trauma might lead to decisions to limit care and that these care limitations might create self-fulfilling prophecies of poor outcome in individual patients have been considered 2 3 . Is it also possible that a hospital milieu in which care limitation is commonly sought might also influence overall aggressiveness of care for other patients as well
