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2 "do-not-resuscitate order"
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The End-of-Life Care in the Intensive Care Unit
Jae Young Moon, Yong Sup Shin
Korean J Crit Care Med. 2013;28(3):163-172.
DOI: https://doi.org/10.4266/kjccm.2013.28.3.163
  • 3,616 View
  • 161 Download
  • 8 Crossref
AbstractAbstract PDF
The intensive care units (ICUs) provide the best possible medical care to help critically ill patients survive acute threats to their lives. At the same time, the ICU is also the most common place to die. Thus the ICU clinicians should be competent in all aspects for end-of-life (EOL) care. The quality of EOL care in Korean ICUs do not ensure ICU patient's autonomy and dignity at their end-of-life. For examples, several studies present that do-not-resuscitate (DNR) orders are only initiated when the patient's death in imminent. To improve understanding EOL care of terminally ill patients, we summarize 'Recommendations for EOL care in the ICU by the American College of Critical Care Medicine' and 'Consensus guidelines to withdrawing life-sustaining therapies endorsed by Korean Academy of Medical Science'. EOL care will be emerging as a comprehensive area of expertise in Korean ICUs. The ICU clinicians must strive to find the barriers for EOL care in the ICU and develop their processes to improve the care of EOL.

Citations

Citations to this article as recorded by  
  • A Scoping Review of End-Of-Life Care Education Programs for Critical Care Nurses
    Eugene HAN, Sumi CHOI, Ki Young YUN, Sung Ha KIM, Sanghee KIM, Hye Young YUN
    Korean Journal of Medical Ethics.2023; 26(3): 185.     CrossRef
  • Comparison of the Characteristics Among Deceased Do-Not-Attempt-Resuscitation (DNAR) Cancer Patients in Hospice and Oncology Wards
    Nan Song, Ja Yun Choi
    Asian Oncology Nursing.2020; 20(1): 10.     CrossRef
  • Relationship of ICU Nurses' Difficulties in End-of-Life Care to Moral Distress, Burnout and Job Satisfaction
    Kkot Bi Jeon, Mihyun Park
    Journal of Korean Academy of Nursing Administration.2019; 25(1): 42.     CrossRef
  • Difficulties in End-of-Life Care and Educational Needs of Intensive Care Unit Nurses: A Mixed Methods Study
    Hyun Sook Kim, Eun Kyoung Choi, Tae Hee Kim, Hye Young Yun, Eun Ji Kim, Jin Ju Hong, Jeong A Hong, Geon Ah Kim, R.N. Sung Ha Kim
    The Korean Journal of Hospice and Palliative Care.2019; 22(2): 87.     CrossRef
  • Factors Influencing Performance of End-of-life Care by ICU Nurses
    Mun Jung Ko, So-Hyun Moon
    Journal of Korean Academy of Psychiatric and Mental Health Nursing.2016; 25(4): 327.     CrossRef
  • Development of an Electronic Document for DNR Informed Consent based on the Electronic Medical Record System
    Ji-Kyeong Park
    The Korean Journal of Health Service Management.2016; 10(3): 99.     CrossRef
  • Evaluation of Informed Consent for Withholding and Withdrawal of Life Support in Korean Intensive Care Units
    Jin Ha Park, Shin Ok Koh, Jin Sun Cho, Sungwon Na
    The Korean Journal of Critical Care Medicine.2015; 30(2): 73.     CrossRef
  • Application of Animation Mobile Electronic Informed Consent in Inpatient of Long-term Care Hospital: Focused on DNR Informed Consent
    Ji-Kyeong Park, Ji-On Kim
    Journal of Digital Convergence.2015; 13(11): 187.     CrossRef
Original Article
Do-not-resuscitate Order in Patients, Who Were Deceased in a Medical Intensive Care Unit of an University Hospital in Korea
Kwangha Lee, Hang Jea Jang, Sang Bum Hong, Chae Man Lim, Younsuck Koh
Korean J Crit Care Med. 2008;23(2):84-89.
DOI: https://doi.org/10.4266/kjccm.2008.23.2.84
  • 3,763 View
  • 60 Download
  • 16 Crossref
AbstractAbstract PDF
BACKGROUND
Do-not-resuscitate (DNR) in the event of a cardiac arrest is the most common and important discussion between a patient's family and physicians among the end-of-life decision-making process. To observe the performance of a DNR order in critically ill patients, we analyzed the incidence of DNR orders, the changes in therapeutic levels after DNR orders, and the cases of violated DNR codes in patients who had died in a Korean medical intensive care unit (ICU) between 1 January 2006 and 30 June 2006.
METHODS
The charts of patients who had died in the medical ICU were retrospectively reviewed.
RESULTS
One hundred two patients were enrolled. The ICU and hospital lengths of stay of the patients were 12.4 +/- 14.0 and 23.2 +/- 21.1 days, respectively. Hematologic malignancy (24.5%) accounted for the most common premorbid diagnosis before ICU admission. Seventy-five patients (73.5%) had DNR orders. The DNR order was suggested by the physician in 96% of the patients. There was no significant difference in the clinical parameters and the performance of a DNR order. Eighty-four percent of the patients with a DNR order had received the order within 3 days death. The withholding of additional therapy or withdrawing of current therapy occurred in 57.3% of the patients. The DNR order was violated in 9 cases (12%).
CONCLUSIONS
DNR orders are well-accepted by the patient's family in the ICU. However, DNR orders are initiated when patient death is imminent.

Citations

Citations to this article as recorded by  
  • Act on Decisions on Life-Sustaining Treatment and Timing of Referral to Hospice
    Han-na Ju, Seung Hun Lee, Yun-Jin Kim, Sang-Yeoup Lee, Jeong-Gyu Lee, Yu-Hyeon Yi, Young-Hye Cho, Young-Jin Tak, Hye-Rim Hwang, Eun-Ju Park, Young-In Lee
    Korean Journal of Family Practice.2021; 11(5): 331.     CrossRef
  • Reversals in Decisions about Life-Sustaining Treatment and Associated Factors among Older Patients with Terminal Stage of Cardiopulmonary Disease
    Jung-Ja Choi, Su Hyun Kim, Shin-Woo Kim
    Journal of Korean Academy of Nursing.2019; 49(3): 329.     CrossRef
  • End-of-Life Care Practice in Dying Patients with Do-Not-Resuscitate Order: A Single Center Experience
    Sang Eun Yoon, Eun Mi Nam, Soon Nam Lee
    The Korean Journal of Hospice and Palliative Care.2018; 21(2): 51.     CrossRef
  • Intensive Care Nurses’ Experiences of Death of Patients with DNR Orders
    Ji Yun Lee, Yong Mi Lee, Jae In Jang
    The Korean Journal of Hospice and Palliative Care.2017; 20(2): 122.     CrossRef
  • Trends in the Use of Intensive Care by Very Elderly Patients and Their Clinical Course in a Single Tertiary Hospital in Korea
    Junghyun Kim, Jungkyu Lee, Sunmi Choi, Jinwoo Lee, Young Sik Park, Chang-Hoon Lee, Jae-Joon Yim, Chul-Gyu Yoo, Young Whan Kim, Sung Koo Han, Sang-Min Lee
    Korean Journal of Critical Care Medicine.2016; 31(1): 25.     CrossRef
  • Clinical Characteristics of Oncologic Patients with DNR Decision at a Tertiary Hospital
    Na Young Kang, Jeong Yun Park
    The Korean Journal of Hospice and Palliative Care.2016; 19(1): 26.     CrossRef
  • Evaluation of Informed Consent for Withholding and Withdrawal of Life Support in Korean Intensive Care Units
    Jin Ha Park, Shin Ok Koh, Jin Sun Cho, Sungwon Na
    The Korean Journal of Critical Care Medicine.2015; 30(2): 73.     CrossRef
  • Do-not-resuscitation in Terminal Cancer Patient
    Jung Hye Kwon
    The Korean Journal of Hospice and Palliative Care.2015; 18(3): 179.     CrossRef
  • Research Trend Analysis of Do-Not-Resuscitate Decision: Based on Text Network Analysis
    Miji Kim, Sangmi Noh, Eunjung Ryu, Sangmoon Shin
    Asian Oncology Nursing.2014; 14(4): 254.     CrossRef
  • The Current Status of Medical Decision-Making for Dying Patients in a Medical Intensive Care Unit: A Single-Center Study
    Kyunghwa Shin, Jeong Ha Mok, Sang Hee Lee, Eun Jung Kim, Na Ri Seok, Sun Suk Ryu, Myoung Nam Ha, Kwangha Lee
    Korean Journal of Critical Care Medicine.2014; 29(3): 160.     CrossRef
  • The End-of-Life Care in the Intensive Care Unit
    Jae Young Moon, Yong Sup Shin
    Korean Journal of Critical Care Medicine.2013; 28(3): 163.     CrossRef
  • Medical Residents' Perception and Emotional Stress on Withdrawing Life-Sustaining Therapy
    Jae Young Moon, Hee Young Lee, Chae-Man Lim, Younsuck Koh
    Korean Journal of Critical Care Medicine.2012; 27(1): 16.     CrossRef
  • Current status of end-of-life care in Korean hospitals
    Younsuck Koh
    Journal of the Korean Medical Association.2012; 55(12): 1171.     CrossRef
  • Changes in how ICU nurses perceive the DNR decision and their nursing activity after implementing it
    Young-Rye Park, Jin-A Kim, Kisook Kim
    Nursing Ethics.2011; 18(6): 802.     CrossRef
  • The Preference for Care Near the End of Life of Korean Nurses
    Hyun Sook Kim, Shinmi Kim, Su Jeong Yu, Moungok Kim
    The Korean Journal of Hospice and Palliative Care.2010; 13(1): 41.     CrossRef
  • Physician's Role and Obligation in the Withdrawal of Life-sustaining Management
    Younsuck Koh
    Journal of the Korean Medical Association.2009; 52(9): 871.     CrossRef

ACC : Acute and Critical Care