Supplementary Material for: Approach to the Do-Not-Resuscitate patient in the periendoscopic period – survey about the current Portuguese reality

Background and Aims: Cardiopulmonary arrest is a rare but possible complication of endoscopic procedures, particularly when performed under sedation and/or analgesia. Hospitalized patients, and probably those with a Do Not Resuscitate (DNR) order, present a higher risk of severe cardiopulmonary complications during endoscopy. The request for endoscopic examination, particularly urgent procedures, is becoming increasingly more frequent in patients with Do-Not-Resuscitate orders. This study aimed to assess current practices, concepts and guideline awareness of nationally surveyed Portuguese gastroenterologists regarding the approach to code status for DNR patients in the periendoscopic period. Methods: Online anonymous and self-administered survey was adapted to the Portuguese reality and was conducted to assess gastroenterologists and gastroenterology trainees’ basic demographics data and details about current practice, personal opinions and knowledge of existing guidelines concerning the reversal of periprocedural DNR orders. Results: One hundred and forty five gastroenterologists, including 26 trainees (17.9%), responded to the survey. In patients with a DNR order, code status is rarely discussed (<25% of cases) with the patient/legal representative (66.9%, n=97) or hospitalist (58.6%, n=85) and the DNR order is also rarely reversed (reversal in all (100% of cases) or most cases (75-99% of cases) in 8.3% n=12). Most respondents were unaware of the procedures necessary for DNR prescription in Portugal (81.3%, n=118), as well as existing guidelines on DNR reversal (96.5%, n=140). Regarding personal beliefs, the majority considered that in these patients, the DNR order should be reversed to an intermediate option that includes limited resuscitation maneuvers (62.1%, n=90) and that the urgency of a procedure should not influence the decision to reverse DNR (n=89, 61.4%). There was consensus on the need for recommendations on this topic for gastroenterologists (97.9%, n=142). Conclusion: Portuguese gastroenterologists usually do not revisit the DNR order before endoscopic procedures as a matter of course and consequently do not reverse it. Furthermore, we found significant variation in practices and beliefs among Portuguese gastroenterologists in their approach to the patient w

背景与目的：心搏骤停是内镜操作罕见但可预见的并发症，尤其在实施镇静和/或镇痛操作时风险更高。住院患者，以及持有不复苏医嘱（Do Not Resuscitate, DNR）的患者，在内镜检查期间发生严重心肺并发症的风险进一步升高。当前，持有不复苏医嘱的患者申请内镜检查、尤其是急诊内镜操作的需求正日益攀升。本研究旨在通过对葡萄牙全国胃肠病医师开展问卷调查，评估其在内镜围术期（periendoscopic period）针对不复苏医嘱患者的临床决策流程、相关认知及指南知晓现状。
方法：本研究适配葡萄牙临床实际，采用在线匿名自填式问卷调查，收集胃肠病医师及胃肠病受训医师的基本人口学数据，同时调研其当前临床实践、个人观点，以及对围操作期不复苏医嘱撤销相关现行指南的认知情况。
结果：共计145名胃肠病医师参与本次调查，其中26名为受训医师，占比17.9%。对于持有不复苏医嘱的患者，仅极少比例（<25%）的病例会与患者/法定代理人（66.9%，n=97）或管床住院医师（58.6%，n=85）讨论其复苏决策状态（code status），且不复苏医嘱的撤销率同样极低：仅8.3%的受访者（n=12）表示会在全部（100%病例）或多数（75%-99%病例）病例中撤销该医嘱。多数受访者不了解葡萄牙境内开具不复苏医嘱所需的流程（81.3%，n=118），也对不复苏医嘱撤销相关的现行指南一无所知（96.5%，n=140）。
在个人认知层面，大多数受访者认为此类患者的不复苏医嘱应调整为包含有限复苏措施的中间方案（62.1%，n=90），且操作的紧急程度不应影响不复苏医嘱的撤销决策（n=89，61.4%）。绝大多数受访者（97.9%，n=142）一致认为需要为胃肠病医师制定该主题的官方指南推荐意见。
结论：葡萄牙胃肠病医师通常不会常规在内镜操作前复核不复苏医嘱，因此也不会撤销该医嘱。此外，本研究发现葡萄牙胃肠病医师在处理不复苏医嘱患者的临床实践与认知方面存在显著差异，其针对患者的[原文未完结]