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Background <p>The guidelines for treatment of patients with severe infection or sepsis do not include the indications for endotracheal intubation, nor do they address DNAR/DNI orders.</p> Methods <p>We aimed to describe the rates, characteristics and association (or lack thereof) between tracheal intubation and DNI/DNAR orders among elderly patients with severe infection or sepsis who died within 48&#xa0;h of hospital admission. We conducted a single-center, retrospective, case-controlled study at a tertiary medical center. Adult patients aged ≥ 65 years with severe infection or sepsis who died within 48&#xa0;h of admission were included. Data on demographics, comorbidities, DNAR/DNI status, intubation, and end-of-life (EoL) discussions were collected and analyzed.</p> Results <p>Of the 304 patients included, 29.9% underwent tracheal intubation. Only 14.5% of patients (44/304) had pre-existing DNAR/DNI orders, while 71.1% received such orders within 48&#xa0;h. The presence of DNAR/DNI orders was strongly associated with lower intubation rates (<i>p</i> &lt; 0.0001). However, 12.2% of patients with a DNAR/DNI order from the current hospitalization were intubated. Gaps in documentation were common: 18.1% had no recorded EoL discussions, and in many cases, EoL discussions occurred only after intubation.</p> Conclusions <p>In elderly patients with severe infection or sepsis who died within 48&#xa0;h of admission, tracheal intubation rates were higher than previously reported, while pre-existing DNAR/DNI orders were rare despite a high comorbidity load. DNAR/DNI orders were associated with reduced intubation rates but were inconsistently followed, especially pre-hospital. Poor timing and documentation of end-of-life discussions suggest a need for earlier, structured communication and better integration of patient wishes across care settings.</p>

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Intubation and DNI/DNAR practices in elderly patients dying early from severe infection

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  • 发表日期：

    2026年4月26日

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  • Granit Pariente,
  • Sharon Einav,
  • Daniel D. Gold

摘要

Background

The guidelines for treatment of patients with severe infection or sepsis do not include the indications for endotracheal intubation, nor do they address DNAR/DNI orders.

Methods

We aimed to describe the rates, characteristics and association (or lack thereof) between tracheal intubation and DNI/DNAR orders among elderly patients with severe infection or sepsis who died within 48 h of hospital admission. We conducted a single-center, retrospective, case-controlled study at a tertiary medical center. Adult patients aged ≥ 65 years with severe infection or sepsis who died within 48 h of admission were included. Data on demographics, comorbidities, DNAR/DNI status, intubation, and end-of-life (EoL) discussions were collected and analyzed.

Results

Of the 304 patients included, 29.9% underwent tracheal intubation. Only 14.5% of patients (44/304) had pre-existing DNAR/DNI orders, while 71.1% received such orders within 48 h. The presence of DNAR/DNI orders was strongly associated with lower intubation rates (p < 0.0001). However, 12.2% of patients with a DNAR/DNI order from the current hospitalization were intubated. Gaps in documentation were common: 18.1% had no recorded EoL discussions, and in many cases, EoL discussions occurred only after intubation.

Conclusions

In elderly patients with severe infection or sepsis who died within 48 h of admission, tracheal intubation rates were higher than previously reported, while pre-existing DNAR/DNI orders were rare despite a high comorbidity load. DNAR/DNI orders were associated with reduced intubation rates but were inconsistently followed, especially pre-hospital. Poor timing and documentation of end-of-life discussions suggest a need for earlier, structured communication and better integration of patient wishes across care settings.