DNRについて考える - jikeimasuika.jp

1 DNR ICU 2017 3 14 DNR DNAR DNRDNAR DNAR 2014 INTENSIVIST 2012 :End-of-life 2014 : 80 1-2 DNR DNAR DNR DNAR ICU DNR DNAR DNR DNAR ICU DNR DNAR DNR DNAR DNR DNAR MVCPR ICU 2016 DNR 40 N Engl J Med. 2016 Aug 11;375(6):504-6. The DNR Order after 40 Years Jeffrey P. Burns, , , and Robert D. Truog, DNR 40 DNR 1 CPR ECPR CPR N Engl J Med.

2 2016 Aug 11;375(6):504-6. DNR DNAR A B DNR DNAR DNR DNAR CPR DNAR CPR DNAR DNR DNAR 4 autonomy beneficence non-maleficence donotharm, avoid harm justice CPR ICU DNR DNAR Donottreat DNAR Guidelines Standards for CPR and ECCJAMA 1992;268 DNAR DNAR Do Not AttemptResuscitation 1989 2000 Futility Harm DNR DNAR DNAR DNR DNAR DNR DNARNEnglJMed.

3 1989 Mar 9;320(10) 1960 CPR 60 CPR 60 CPR 1970 - DNR 1974 AMA CPR DNAR CPR DNR CPR chemicalcode,slowcode,showcode,Hollywood codeJAMA 1974;227(Suppl) 1975 1976 1976 NEJM Orders not to resuscitate DNR 1982 1983 DNAR DNR N EnglJ Med 1976; 295:364-6. DNR 1989 DNAR 1990 1991 AMA DNR 1992 AHA DNAR 2000 DNAR AND Allow Natural Death No CPR Guidelines Standards for CPR and ECC DNAR N EnglJ Med 1989;32 DNR DNAR DNAR Crit Care Med.

4 2003 May;31(5):1543-50. JAMA. 1991 Apr 10;265(14) 2. 3. DNR 4. 5. 1991 DNR 1980 DNR 1990 DNR 1994 1970-80 1991 DNR 10-20 DNAR 1994;43:600-11. 1990 - 1990 2000 DNAR 1995 KCL 2003 2004 2005 2005 2006 2006 2008 2009 2000 2006 2007 2008 2009 2010 2014 3 2015 2016 DNR DNAR 40 2016 12 16 Do Not Attempt Resuscitation DNAR Do Not Attempt Resuscitation DNAR DNAR

5 DNR DNAR DNR DNAR CPR 2016 10 86 595 DNR DNAR DNR DNAR DNR DNAR 2012 9 2012 DNR DNAR DNR DNAR 1-3 47 DNAR DNAR DNR DNAR 8% 24% DNR DNAR ADL ADL CPR ADL DNR DNAR DNR DNAR DNR DNAR ADL ADL DNR DNAR DNR DNAR 7 ADL DNR DNAR DNR DNAR ADL 1 DNR DNAR ADL DNR DNAR 8 ADL DNR DNAR 7

6 7 DNR DNAR DNR DNAR DNR DNAR CPR CPR 543 90 ADL DNR DNAR DNAR DNR DNAR ADL CPR DNR DNAR DNR DNAR CPR DNR DNAR DNR DNAR DNAR DNAR DNAR DNAR IC DNAR DNAR DNR DNAR Do Not Attempt Resuscitation DNAR Do Not Attempt Resuscitation DNAR DNAR 2016 12 16 Do Not Attempt Resuscitation DNAR DNAR POLST-Physician Orders for Life Sustaining

7 Treatment-(DNAR ) ( ) 1 Do Not Attempt Resuscitation(DNAR) DNAR ICU Do Not Attempt Resuscitation(DNAR) CPR MVCPR ICU DNR DNAR DNR DNAR Do Not Attempt Resuscitation(DNAR) DNAR DNAR DNAR DNAR Do Not Attempt Resuscitation(DNAR) DNR DNAR DNRDNAR DNR DNAR DNR DNAR DNRDNAR DNAR Do Not Attempt Resuscitation(DNAR) 3 Do Not Attempt Resuscitation(DNAR) 2015 1.

8 2. 3. 4. 2007 2015 1. (1) (2) (3) 2. (1) (2) (3) 3. 2014 3 1.

9 2. 3. 4. 3 1. 2. 3. 4. 2014 3 3 Do Not Attempt Resuscitation(DNAR) DNAR Do Not Attempt Resuscitation(DNAR) Do Not Attempt Resuscitation(DNAR) Partial DNAR DNAR Do Not Attempt Resuscitation(DNAR) Do Not Attempt Resuscitation(DNAR)

10 POLST-Physician Orders for Life Sustaining Treatment- DNAR POLST DNAR POLST DNAR POLST Do Not Attempt Resuscitation(DNAR) POLST Physician Orders for Life-Sustaining Treatment 1 50 40 A CPR B C D 4 2014 : POLST POLST POLST Physician Orders for Life-sustaining Treatment POLST Do Not Attempt Resuscitation DNAR Do Not Attempt Resuscitation(DNAR) DNAR DNAR Do Not Attempt Resuscitation(DNAR) DNR DNAR DNR DNAR ICU DNR DNAR DNR DNAR DNR DNAR DNR DNAR