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Code status orders in patients admitted to the intensive care unit with COVID-19: A retrospective cohort study.
Moin, Emily E; Okin, Daniel; Jesudasen, Sirus J; Dandawate, Nupur A; Gavralidis, Alexander; Chang, Leslie L; Witkin, Alison S; Hibbert, Kathryn A; Kadar, Aran; Gordan, Patrick L; Bebell, Lisa M; Lai, Peggy S; Alba, George A.
  • Moin EE; Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
  • Okin D; Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
  • Jesudasen SJ; Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.
  • Dandawate NA; Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
  • Gavralidis A; Department of Medicine, Salem Hospital, Salem, MA, USA.
  • Chang LL; Department of Medicine, Salem Hospital, Salem, MA, USA.
  • Witkin AS; Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
  • Hibbert KA; Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.
  • Kadar A; Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.
  • Gordan PL; Division of Pulmonary Medicine and Critical Care, Newton-Wellesley Hospital, Newton, MA, USA.
  • Bebell LM; Department of Medicine, Salem Hospital, Salem, MA, USA.
  • Lai PS; Division of Pulmonary, Critical Care and Sleep Medicine, Salem Hospital, Salem, MA, USA.
  • Alba GA; Division of Infectious Diseases, Medical Practice Evaluation Center and Center for Global Health, Massachusetts General Hospital, Boston, MA, USA.
Resusc Plus ; 10: 100219, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1852002
ABSTRACT

Purpose:

Code status orders impact clinical outcomes as well as patients' and surrogates' experiences. This is the first multicenter cohort examining code status orders of ICU patients with COVID-19 reported to date. Materials and

methods:

This is a retrospective cohort study including adult patients who tested positive for SARS-CoV-2 and were admitted to the ICU at three hospitals in Massachusetts from March 11, 2020 - May 31, 2020. We examined differences in code status orders at multiple timepoints and performed multivariable regression analysis to identify variables associated with code status at admission.

Results:

Among 459 ICU patients with COVID-19, 421 (91.7%) were Full Code at hospital admission. Age and admission from a facility were positively associated with DNR status (adjusted OR 1.10, 95% CI 1.05-1.15, p < 0.001 and adjusted OR 2.68, CI 1.23-5.71, p = 0.011, respectively) while non-English preferred language was negatively associated with DNR status (adjusted OR 0.29, 95% CI 0.10-0.74, p = 0.012). Among 147 patients who died during hospitalization, 95.2% (140) died with DNR code status; most (86.4%) died within two days of final code status change.

Conclusions:

The association of non-English preferred language with Full Code status in critically ill COVID-19 patients highlights the importance of medical interpreters in the ICU. Patients who died were transitioned to DNR more than in previous studies, possibly reflecting changes in practice during a novel pandemic.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study / Qualitative research Language: English Journal: Resusc Plus Year: 2022 Document Type: Article Affiliation country: J.resplu.2022.100219

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study / Qualitative research Language: English Journal: Resusc Plus Year: 2022 Document Type: Article Affiliation country: J.resplu.2022.100219