Trial reportAnnals of the American Thoracic Society2014
"Do not resuscitate" decisions in acute respiratory distress syndrome. A secondary analysis of clinical trial data.
Trial report in Annals of the American Thoracic Society, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
- Limitation of Life-Sustaining Care in the Critically Ill: A Systematic Review of the Literature.Journal of hospital medicine · 2019Pooled it
- Inhaled AP301 for treatment of pulmonary edema in mechanically ventilated patients with acute respiratory distress syndrome: a phase IIa randomized placebo-controlled trial.Critical care (London, England) · 2017Trial
- Association of Hyperinflammatory Subphenotype With Code Status De-Escalation in Patients With Acute Respiratory Failure.CHEST critical care · 2024Article
- Code status orders in patients admitted to the intensive care unit with COVID-19: A retrospective cohort study.Resuscitation plus · 2022Article
- If Your Heart Were to Stop: Characterization and Comparison of Code Status Orders in Adult Patients Admitted with COVID-19.Journal of palliative medicine · 2022Article
- Outcome after intubation for septic shock with respiratory distress and hemodynamic compromise: an observational study.BMC anesthesiology · 2021Observational
- Contemporary strategies to improve clinical trial design for critical care research: insights from the First Critical Care Clinical Trialists Workshop.Intensive care medicine · 2020Article
- Competing and conflicting interests in the care of critically ill patients.Intensive care medicine · 2018Review
- Accounting for Patient Preferences Regarding Life-Sustaining Treatment in Evaluations of Medical Effectiveness and Quality.American journal of respiratory and critical care medicine · 2017Article
- Article
- CCCS-SSAI WikiRecs clinical practice guideline: vasopressor blood pressure targets in critically ill adults with hypotension and vasopressor use in early traumatic shock.Intensive care medicine · 2017Article
- Further deliberating the relationship between do-not-resuscitate and the increased risk of death.Scientific reports · 2016Article
- High Mortality in Severe Sepsis and Septic Shock Patients with Do-Not-Resuscitate Orders in East Asia.PloS one · 2016Article
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
Abstract
rationaleFactors and outcomes associated with end-of-life decision-making among patients during clinical trials in the intensive care unit are unclear.
objectivesWe sought to determine patterns and outcomes of Do Not Resuscitate (DNR) decisions among critically ill patients with acute respiratory distress syndrome (ARDS) enrolled in a clinical trial.
methodsWe performed a secondary analysis of data from the ARDS Network Fluid and Catheter Treatment Trial (FACTT), collected between 2000 and 2005. We calculated mortality outcomes stratified by code status, and compared baseline characteristics of patients who became DNR during the trial with participants who remained full code. MEASUREMENTS AND MAIN
resultsAmong 809 FACTT participants with a code status recorded, 232 (28.7%) elected DNR status. Specifically, 37 (15.9%) chose to withhold cardiopulmonary resuscitation alone, 44 (19.0%) elected to withhold some life support measures in addition to cardiopulmonary resuscitation, and 151 (65.1%) had life support withdrawn. Admission severity of illness as measured by APACHE III score was strongly associated with election of DNR status (odds ratio, 2.2; 95% confidence interval, 1.85-2.62; P < 0.0001). Almost all (97.0%; 225 of 232) patients who selected DNR status died, and 79% (225 of 284) of patients who died during the trial were DNR. Among patients who chose DNR status but did not elect withdrawal of life support, 91% (74 of 81) died.
conclusionsThe vast majority of deaths among clinical trial patients with ARDS were preceded by a DNR order. Unlike other studies of end-of-life decision-making in the intensive care unit, nearly all patients who became DNR died. The impact of variation of practice in end-of-life decision-making during clinical trials warrants further study.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.