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Gaspar L, Reis N, Sousa P, Silva APE, Cardoso A, Brito A, Bastos F, Campos J, Parente P, Pereira F, Machado N. Nursing Process Related to the Nursing Focus "Airway Clearance": A Scoping Review. NURSING REPORTS 2024; 14:1871-1896. [PMID: 39189270 PMCID: PMC11348224 DOI: 10.3390/nursrep14030140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Airway clearance impairment has a significant impact on self-care and quality of life. Identifying clinical data, nursing diagnoses, and nursing interventions is essential to clinical reasoning and enhancing nursing care. This study aims to map the existing evidence on clinical data, nursing diagnoses, and nursing interventions addressing the nursing focus on "airway clearance". METHODS Research was conducted based on Joanna Briggs's Scoping Review Methodology. We searched four databases for published studies until December 2023. RESULTS From the initial 1854 studies identified, 123 were included in the review. The findings highlighted two areas of nursing attention: one related to signs and symptom management, and the other related to education and coping strategies. The data that led to nursing diagnoses were divided into cognitive and clinical data. The nursing diagnoses were mostly related to secretion retention, excessive mucus production, and airway obstruction. The most commonly identified nursing interventions were educational interventions assembled into predesigned education programs rather than patient-tailored programs. CONCLUSIONS Findings can add substantial value for systematizing the nursing process related to "airway clearance", improving nursing decision-making and care quality. This study was prospectively registered with the Open Science Framework (OSF) on 02 December 2022, with the registration number wx5ze.
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Affiliation(s)
- Luís Gaspar
- Faculty of Health Sciences and Nursing, Universidade Universidade Católica Portuguesa, 4169-005 Porto, Portugal;
| | - Neuza Reis
- Faculty of Health Sciences and Nursing, Universidade Universidade Católica Portuguesa, 4169-005 Porto, Portugal;
| | - Paula Sousa
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Abel Paiva e Silva
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Alexandrina Cardoso
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Alice Brito
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Fernanda Bastos
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Joana Campos
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Paulo Parente
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Filipe Pereira
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Natália Machado
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
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de Candia ML, Coppola A, Romano GE, Carpagnano GE, Pierucci P. Concise review of end of life and palliative care in neuromuscular pathologies: still a long pathway ahead. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2024; 43:71-77. [PMID: 39082324 PMCID: PMC11305353 DOI: 10.36185/2532-1900-431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/16/2024] [Indexed: 08/10/2024]
Abstract
Introduction Neuromuscular diseases (NMD) include different types of diseases depending on the deficient component of the motor unit involved. They may all be interested by a progressive and sometimes irreversible pump respiratory failure which unfortunately for some NMD may start soon after the diagnosis. Within this vast group of patients those affected by muscle diseases are a subgroup who comprises patients with an average earlier onset of symptoms compared to other NMD. Indeed it is also important to comprehend not just the patient's burden but also the surrounding families'. Defining the end of life (EoL) phase in these patients is not simple especially in the young patient population. Consequently, the late stage of disease remains poorly defined and challenging. Objectives The aim of this review is to describe the EoL phase in NMD patients with attention to QoL and psycological status. Methods The focus would be on one hand on the management of the psychological burden, the communication barriers, and tone of humor. Results Those topics have been described being crucial in this group of patients as they increase tensions and burden of both patient and family, and between them and the outside world. Thus also causing their social isolation, increasing anxiety and reducing their quality of life. On the other hand the use of cough clearance devices and all the respiratory supports and their withdrawn are carefully evaluated in the view of alleviating respiratory symptoms, improving patient quality of life and above all reaching the patient's goals of care. Conclusions Although there is no cure, the advent of supportive interventions including multidisciplinary care (MDC) has improved all the aspects of dying for patients affected by NMD; nevertheless there still a long pathway ahead.
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Affiliation(s)
| | - Antonietta Coppola
- UOC Fisiopatologia e Riabilitazione Respiratoria, Ospedale Monaldi, AO dei Colli, Napoli, Italy
| | - Gualtiero Ermando Romano
- Dipartimento di Biomedicina Traslazionale e Neuroscienze, UO di Malattie dell’Apparato Respiratorio, Azienda Ospedaliera Universitaria Consorziale, Policlinico di Bari, Italy
| | - Giovanna Elisiana Carpagnano
- Dipartimento di Biomedicina Traslazionale e Neuroscienze, UO di Malattie dell’Apparato Respiratorio, Azienda Ospedaliera Universitaria Consorziale, Policlinico di Bari, Italy
| | - Paola Pierucci
- Dipartimento di Biomedicina Traslazionale e Neuroscienze, UO di Malattie dell’Apparato Respiratorio, Azienda Ospedaliera Universitaria Consorziale, Policlinico di Bari, Italy
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Hattori Y, Hamada S, Yamanaka T, Kidana K, Iwagami M, Sakata N, Tamiya N, Kojima T, Ogawa S, Akishita M. Drug prescribing changes in the last year of life among homebound older adults: national retrospective cohort study. BMJ Support Palliat Care 2024; 13:e1156-e1165. [PMID: 35831182 DOI: 10.1136/spcare-2022-003639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/21/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study aimed to evaluate the prescription patterns of drugs during the last year of life in homebound older adults who received home medical care. METHODS We used a nationwide claims database in Japan and selected older adults aged ≥75 years who received home medical care services from ≥12 months before their death. We evaluated medications prescribed 12 months before death (month 12), 3 months before death (month 3) and in the last month of life (month 1). We explored the factors associated with the decreased number of cardiovascular preventive drugs from month 12 to both month 3 and month 1. RESULTS A total of 118 661 participants were included, and the majority were aged ≥90 years and women. The prevalence of cardiovascular preventive drugs decreased but remained common in month 1, which included antihypertensives (34.7%), antiplatelets (15.9%), oral anticoagulants (7.6%), antidiabetic drugs (7.3%) and lipid-lowering drugs (6.1%). The relative decrease from month 12 to month 1 was the largest for lipid-lowering drugs (44.8%) and the smallest for oral anticoagulants (13.6%). Among other drugs, laxatives (enema), antiemetics, oral corticosteroids, analgesics, expectorants, bronchodilators and antibiotics showed a large relative increase. Older age, duration of home medical care services for <1 year and diagnoses of cancer, dementia and Parkinson's disease were associated with a greater likelihood of a decreased number of cardiovascular preventive drugs. CONCLUSIONS There is room for deprescribing to avoid inappropriate polypharmacy by balancing preventive and symptom management drugs in those receiving home medical care with a limited life expectancy.
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Affiliation(s)
- Yukari Hattori
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takashi Yamanaka
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiwami Kidana
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Nobuo Sakata
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Navarro-Meléndez A, Gimenez MJ, Robledo-Donascimento Y, Río-González A, Lendínez-Mesa A. Physiotherapy applied to palliative care patients: a descriptive practice-based study. BMC Palliat Care 2023; 22:99. [PMID: 37474943 PMCID: PMC10357741 DOI: 10.1186/s12904-023-01188-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/30/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Over the last few years, the presence of physiotherapists in Palliative Care Units (PCU) has considerably grown based on evidence from studies supporting the use of non-pharmacological measures as part of Palliative Care (PC) treatments. However, more accumulated data are needed to definitively establish its added value. The present study describes the type of patients receiving physiotherapy in a PCU and the benefits obtained in relation to their degree of functional dependence. METHODS An observational, prospective, descriptive, practice-based study was undertaken involving patients admitted to the PCU of Fundación Instituto San José (Madrid, Spain), who according to the PCU´s clinical practice, met the criteria for physiotherapy intervention. Daily clinical practice was unchanged for study reasons. Participants were assessed prior to initiating and at the end of the physiotherapy program using the following standard scales: the Barthel Index, the Functional Ambulation Categories scale, the Palliative Performance Scale, and the Braden scale. A descriptive analysis was performed and scale scores prior to and after treatment were compared using the Wilcoxon signed-rank test. Significance was set at 0.05. RESULTS A total of 63 patients were included (mean age 71.98 ± 12.72; 61.9% males). Fifty-eight patients (92.1%) were oncological patients; of them, 35 (60.3%) had metastases. Prior to treatment, 28 (44.4%) participants had total dependence according to the Barthel index, and 37 (58.7%) were non-functional ambulator according to the FAC scale. At the end of treatment, the number of patients with total dependence decreased to 15 (23.8%) and those non-functional ambulator to 12 (19.0%). CONCLUSIONS Patients who benefited from physical therapy during their admission to our PCU were predominantly males with oncological processes, mainly lung cancer. PC including physiotherapy improved their functionality, independence and skills for activities of daily living in this sample of PCU patients.
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Affiliation(s)
- A Navarro-Meléndez
- Rehabilitation area, Hospital Fundación Instituto San José, Avenida de la Hospitalidad s/n, Madrid, 28054 Spain
- Department of Health Sciences, “San Juan de Dios” School of Nursing and Physical Therapy, Comillas Pontifical University, Avenida San Juan de Dios, 1, Ciempozuelos, 28350 Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, Villaviciosa de Odón, 28670 Spain
| | - MJ Gimenez
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, Villaviciosa de Odón, 28670 Spain
| | - Y Robledo-Donascimento
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, Villaviciosa de Odón, 28670 Spain
- Hospital Universitario del Henares and Centro de Investigación Fisioterapia y Dolor, Avenida de Marie Curie 0, Coslada, 28822 Spain
| | - A Río-González
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, Villaviciosa de Odón, 28670 Spain
| | - A Lendínez-Mesa
- Department of Nursing, Neurology Service. Grupo de Investigación en Cuidados (InveCuid), Hospital 12 de Octubre, Avenida de Córdoba s/n, Madrid, 28041 Spain
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Taburee W, Dhippayom T, Nagaviroj K, Dilokthornsakul P. Effects of Anticholinergics on Death Rattle: A Systematic Review and Network Meta-Analysis. J Palliat Med 2023; 26:431-440. [PMID: 36194053 DOI: 10.1089/jpm.2022.0386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Anticholinergics have been used to treat death rattle (DR) in dying patients with palliative care. However, the effect of anticholinergics is still controversial. No quantitative summary of their effects is reported. Objective: This study aimed to systematically review and quantitatively synthesize the effect of anticholinergics on DR treatment and prophylaxis. Design: A systematic search was performed in the electronic databases (PubMed, Embase®, and Cumulative Index to Nursing and Allied Health Literature [CINAHL]) from inception to October 2021. Studies conducted to determine the effect of anticholinergics compared with other anticholinergics or placebo on noise reduction score in dying patients were included. A network meta-analysis was performed for DR treatment. The effect of anticholinergics at four hours was assessed. A pairwise meta-analysis was performed for DR prophylaxis. Results: A total of nine studies were included with 1103 patients. Six studies were randomized controlled trials, and three studies were cohort studies. Seven studies were conducted for DR treatment, while two studies were conducted for DR prophylaxis. For DR treatment, no statistically significant difference was observed between each anticholinergic (hyoscine hydrobromide, hyoscine butyl bromide, atropine, and glycopyrrolate) and placebo and among any anticholinergics. However, the surface under cumulative ranking curve indicated that hyoscine butyl bromide had the highest surface under the cumulative ranking curve (SUCRA) with 71.3%. For DR prophylaxis, the relative risk of DR occurrence for hyoscine butyl bromide was 0.23 (0.04, 1.18; I2 = 84.5%) compared with no treatment. Conclusion: This study showed no strong evidence of the regular use of anticholinergics for DR treatment. In addition, hyoscine butyl bromide appears to have a high potential for DR prophylaxis.
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Affiliation(s)
- Watcharaporn Taburee
- Department of Family Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Teerapon Dhippayom
- The Research Unit of Evidence Synthesis (TRUES), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Kittiphon Nagaviroj
- Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Piyameth Dilokthornsakul
- Center for Medical and Health Technology Assessment (CM-HTA), Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
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Zhu M, Tao Y, Pu J, Zhao H, Wan L, Zhang P, Tang C. Pharmacokinetics and Bioequivalence of Fudosteine in Healthy Chinese Volunteers Under Fasting and Fed Conditions: A 4-Way Replicate Crossover Study. Clin Pharmacol Drug Dev 2023; 12:30-37. [PMID: 35794358 PMCID: PMC10084052 DOI: 10.1002/cpdd.1137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/08/2022] [Indexed: 01/04/2023]
Abstract
The bioequivalence of a generic fudosteine tablet vs a brand-named fudosteine tablet under fasting and fed conditions was evaluated in this study. This randomized, open-label, single-dose, 4-way replicate, crossover, bioequivalence study included 64 healthy Chinese subjects (fasting cohort, n = 32; fed cohort, n = 32) who were assigned to receive a single 200-mg dose of generic or brand-named fudosteine. Blood samples were collected before dosing and up to 24 hours after dosing. The plasma concentrations of fudosteine were analyzed by high-performance liquid chromatography-tandem mass spectrometry. Safety was monitored. There were no significant differences in maximum plasma concentration (Cmax ), area under the plasma concentration-time curve (AUC) from time 0 to time t (AUC0-t ), or AUC from time 0 to infinity (AUC0-∞ ) between the test and reference formulations. However, food showed a significant effect on Cmax , AUC0-t , and AUC0-∞ for both generic and brand-named fudosteine. The 90%CIs of the test/reference ratios of Cmax , AUC0-t, and AUC0-∞ were within the range of 80% to 125% under both fasting and fed conditions. No serious adverse events were reported. The bioequivalence between generic and brand-named fudosteine under fasting and fed conditions was demonstrated. Both of them had good tolerance for healthy Chinese volunteers. In addition, food delayed the absorption of fudosteine, so taking this medicine before meals might be an optimized option.
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Affiliation(s)
- Mingxue Zhu
- Department of Phase I Clinical Trial Ward, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Tao
- Department of Phase I Clinical Trial Ward, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Junliang Pu
- Department of Phase I Clinical Trial Ward, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongtao Zhao
- Department of Phase I Clinical Trial Ward, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lei Wan
- Department of Phase I Clinical Trial Ward, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peilin Zhang
- Department of Phase I Clinical Trial Ward, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chengyong Tang
- Department of Phase I Clinical Trial Ward, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Wong AK, Philip J, Wawryk O, Sabe MG, Yoong J, Everitt R, Mendis R, Chua J, Pisasale M, Le B. A Multi-Centre COVID-19 Study Examining Symptoms and Medication Use in the Final Week of Life. J Pain Symptom Manage 2022; 64:e139-e147. [PMID: 35644508 PMCID: PMC9134756 DOI: 10.1016/j.jpainsymman.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 11/23/2022]
Abstract
CONTEXT Guidelines exist to direct end-of-life symptom management in COVID-19 patients. However, the real-world symptom patterns, and degree of concordance with guidelines on medication use, and palliative care involvement has received limited attention. OBJECTIVES To describe the evolution of COVID-19 symptoms, medication used to alleviate these, and degree of palliative care involvement in the final week of life. METHODS This retrospective study reviewed all COVID-19 inpatient deaths across five metropolitan hospitals in Australia from January 1 to December 31, 2020. Outcome measures were collected at day of death, and days one, two, five and seven before death. These were COVID-19 symptom severity (measured by the Palliative Care Outcome Scale), and use of supportive pharmacological and non-pharmacological therapies. Palliative care referral timepoint was also collected. RESULTS Within the sample of 230 patients, commonest symptoms were breathlessness, agitation, pain, and respiratory secretions. On day of death, 79% (n = 181) experienced at least one symptom, and 30% (n = 68) experienced severe/extreme symptoms. The use of midazolam, glycopyrrolate, and infusions for symptom management occurred late, less frequently, and at lower doses than suggested in guidelines and other studies. Palliative care referrals were made late, at median three days before death (IQR 1-6 days), and for only half of people dying from COVID-19 (51%; n = 118). CONCLUSION Symptoms peaked in final three days of life. Earlier use of in fusional and breakthrough medications should be considered in anticipation of symptoms given high likelihood of dying in discomfort. Earlier palliative care referral for high-risk patients should be considered at hospital admission.
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Affiliation(s)
- Aaron K Wong
- Parkville Integrated Palliative Care Service (A.K.W., J.P., R.E., J.C., B.L.) Peter MacCallum Cancer Centre & The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine (A.K.W., J.P., O.W.), University of Melbourne, Fitzroy, Victoria, Australia.
| | - Jennifer Philip
- Parkville Integrated Palliative Care Service (A.K.W., J.P., R.E., J.C., B.L.) Peter MacCallum Cancer Centre & The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine (A.K.W., J.P., O.W.), University of Melbourne, Fitzroy, Victoria, Australia
| | - Olivia Wawryk
- Department of Medicine (A.K.W., J.P., O.W.), University of Melbourne, Fitzroy, Victoria, Australia
| | | | - Jaclyn Yoong
- Northern Health (M.G.S., J.Y.), Victoria, Australia
| | - Rachel Everitt
- Parkville Integrated Palliative Care Service (A.K.W., J.P., R.E., J.C., B.L.) Peter MacCallum Cancer Centre & The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Ruwani Mendis
- Western Health (R.M.), St Albans, Victoria, Australia
| | - Joyce Chua
- Parkville Integrated Palliative Care Service (A.K.W., J.P., R.E., J.C., B.L.) Peter MacCallum Cancer Centre & The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Maria Pisasale
- Werribee Mercy Hospital (M.P.), Werribee, Victoria, Australia
| | - Brian Le
- Parkville Integrated Palliative Care Service (A.K.W., J.P., R.E., J.C., B.L.) Peter MacCallum Cancer Centre & The Royal Melbourne Hospital, Parkville, Victoria, Australia
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Polastri M, Cuomo AM. Palliative physiotherapy in end-stage respiratory diseases. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2022.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Massimiliano Polastri
- Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Kaltwasser A, Dubb R. [Endotracheal suctioning]. Med Klin Intensivmed Notfmed 2021; 116:136-137. [PMID: 33095313 PMCID: PMC7582029 DOI: 10.1007/s00063-020-00746-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Arnold Kaltwasser
- Akademie der Kreiskliniken Reutlingen GmbH, Steinenbergstr. 31, 72764, Reutlingen, Deutschland.
| | - Rolf Dubb
- Akademie der Kreiskliniken Reutlingen GmbH, Steinenbergstr. 31, 72764, Reutlingen, Deutschland
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Mottiar M, Hendin A, Fischer L, Roze des Ordons A, Hartwick M. End-of-life care in patients with a highly transmissible respiratory virus: implications for COVID-19. Can J Anaesth 2020; 67:1417-1423. [PMID: 32394338 PMCID: PMC7212843 DOI: 10.1007/s12630-020-01699-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 01/08/2023] Open
Abstract
Symptom management and end-of-life care are core skills for all physicians, although in ordinary times many anesthesiologists have fewer occasions to use these skills. The current coronavirus disease (COVID-19) pandemic has caused significant mortality over a short time and has necessitated an increase in provision of both critical care and palliative care. For anesthesiologists deployed to units caring for patients with COVID-19, this narrative review provides guidance on conducting goals of care discussions, withdrawing life-sustaining measures, and managing distressing symptoms.
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Affiliation(s)
- Miriam Mottiar
- Department of Anesthesiology & Pain Medicine, Division of Palliative Medicine, Department of Medicine, The Ottawa Hospital, University of Ottawa, 501 Smyth Rd, Room 1401, Ottawa, ON, K1H 8L6, Canada.
| | - Ariel Hendin
- Department of Emergency Medicine, Division of Critical Care, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Lisa Fischer
- Department of Emergency Medicine, Division of Palliative Medicine, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Amanda Roze des Ordons
- Department of Anesthesiology, Perioperative and Pain Medicine, Department of Critical Care Medicine, Division of Palliative Medicine, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Michael Hartwick
- Division of Critical Care, Division of Palliative Medicine, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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Rao KS, Singhai P, Salins N, Rao SR. The pathway to comfort: Role of palliative care for serious COVID-19 illness. ACTA ACUST UNITED AC 2020. [PMCID: PMC7485644 DOI: 10.25259/ijms_157_2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The novel coronavirus disease (COVID-19) pandemic has led to significant distress among people of all age groups. Patients with advanced age and severe life-limiting illnesses are at increased risk of death from COVID-19. Not all patients presenting with severe illness will be eligible for aggressive intensive treatment. In limited resource setting, patients may be triaged for supportive care only. This subset of patients should be promptly identified and receive appropriate palliative care with adequate symptom control strategies and psychosocial support. Breathlessness, delirium, pain, and noisy breathing are main symptoms among these patients which can add to the suffering at end-of-life. The COVID-19 pandemic also contributes to the psychological distress due to stigma of the illness, uncertainty of the illness course, fear of death and dying in isolation, and anticipatory grief in families. Empathetic communication and holistic psychosocial support are important in providing good palliative care in COVID-19 patients and their families.
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Affiliation(s)
- Krithika S. Rao
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India,
| | - Pankaj Singhai
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India,
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India,
| | - Seema Rajesh Rao
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India,
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Pan CX, Palathra BC, Leo-To WF. Management of Respiratory Symptoms in Those with Serious Illness. Med Clin North Am 2020; 104:455-470. [PMID: 32312409 DOI: 10.1016/j.mcna.2019.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Respiratory symptoms are common in patients living with serious illness, both in cancer and nonmalignant conditions. Common symptoms include dyspnea (breathlessness), cough, malignant pleural effusions, airway secretions, and hemoptysis. Basic management of respiratory symptoms is within the scope of primary palliative care. There are pharmacologic and nonpharmacologic approaches to treating respiratory symptoms. This article provides clinicians with treatment approaches to these burdensome symptoms.
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Affiliation(s)
- Cynthia X Pan
- Division of Palliative Medicine and Geriatrics, Designated Institution Official of Graduate Medical Education, NewYork-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA; Weill Cornell Medical College, New York, NY, USA.
| | - Brigit C Palathra
- Weill Cornell Medical College, New York, NY, USA; Hospice and Palliative Medicine Fellowship, Division of Palliative Medicine and Geriatrics, NewYork-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA. https://twitter.com/bpalathra
| | - Wing Fun Leo-To
- NewYork-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA; Affiliate Clinical Faculty, College of Pharmacy and Health Science, St John's University, Jamaica, NY, USA
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Salins N, Mani RK, Gursahani R, Simha S, Bhatnagar S. Symptom Management and Supportive Care of Serious COVID-19 Patients and their Families in India. Indian J Crit Care Med 2020; 24:435-444. [PMID: 32863637 PMCID: PMC7435102 DOI: 10.5005/jp-journals-10071-23400] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Coronavirus disease-19 (COVID-19) pandemic is causing a worldwide humanitarian crisis. Old age, comorbid conditions, end-stage organ impairment, and advanced cancer, increase the risk of mortality in serious COVID-19. A subset of serious COVID-19 patients with serious acute respiratory illness may be triaged not to receive aggressive intensive care unit (ICU) treatment and ventilation or may be discontinued from ventilation due to their underlying conditions. Those not eligible for aggressive ICU measures should receive appropriate symptom management. Early warning scores (EWS), oxygen saturation, and respiratory rate, can facilitate categorizing COVID-19 patients as stable, unstable, and end of life. Breathlessness, delirium, respiratory secretions, and pain, are the key symptoms that need to be assessed and palliated. Palliative sedation measures are needed to manage intractable symptoms. Goals of care should be discussed, and advance care plan should be made in patients who are unlikely to benefit from aggressive ICU measures and ventilation. For patients who are already in an ICU, either ventilated or needing ventilation, a futility assessment is made. If there is a consensus on futility, a family meeting is conducted either virtually or face to face depending on the infection risk and infection control protocol. The family should be sensitively communicated about the futility of ICU measures and foregoing life-sustaining treatment. Family meeting outcomes are documented, and consent for foregoing life-sustaining treatment is obtained. Appropriate symptom management enables comfort at the end of life to all serious COVID-19 patients not receiving or not eligible to receive ICU measures and ventilation. How to cite this article: Salins N, Mani RK, Gursahani R, Simha S, Bhatnagar S. Symptom Management and Supportive Care of Serious COVID-19 Patients and their Families in India. Indian J Crit Care Med 2020;24(6):435–444.
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Affiliation(s)
- Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Mahe, Manipal, Karnataka, India
| | - Raj Kumar Mani
- Department of Critical Care and Pulmonology, Batra Hospital and Medical Research Centre, Delhi, India
| | - Roop Gursahani
- Department of Neurology, PD Hinduja National Hospital, Mumbai, Maharashtra, India
| | - Srinagesh Simha
- Department of Palliative Care, Karunashraya, Bengaluru, Karnataka, India
| | - Sushma Bhatnagar
- Department of Onco-anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
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Kulnik ST. Could reflex cough induced through nebulized capsaicin achieve airway clearance in patients with acute retention of lung secretions? Med Hypotheses 2018; 119:104-109. [PMID: 30122479 DOI: 10.1016/j.mehy.2018.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/30/2018] [Accepted: 08/04/2018] [Indexed: 10/28/2022]
Abstract
Nasotracheal suctioning (NTS) is a procedure commonly performed by respiratory physiotherapists and nurses to remove excess respiratory secretions from the tracheobronchial tree in a self-ventilating, non-intubated and non-tracheotomized patient. NTS is an important treatment modality for patients with acute secretion retention who are at high risk of progressive respiratory deterioration and arrest. However, NTS is a blind invasive procedure with risk of serious adverse events, and the patient experience of NTS is often extremely negative. Capsaicin, a substance extracted from cayenne pepper, elicits reflex coughs when inhaled. It is hypothesized that capsaicin-induced reflex cough may offer an alternative treatment option to NTS. It is suggested that repeated reflex cough bouts, elicited through inhalation of nebulized capsaicin via a facemask, could achieve clearance of retained secretions from the tracheobronchial tree to the oropharynx, thereby avoiding the need for NTS. This hypothesis is supported by preliminary cough flow data from a stroke trial. Stroke patients underwent assessments of peak cough flow (PCF, a measure of cough effectiveness) of both maximal volitional cough and capsaicin-induced reflex cough. In a sub-group of 20 stroke patients with weak volitional cough (mean PCF 220 L/min, SD 80), PCF of capsaicin-induced reflex cough was on average 184 L/min (SD 130) higher than PCF of subjects' maximal volitional cough effort. Cough flow traces indicate a pattern of cough augmentation during consecutive reflex cough bouts. It is suggested that the hypothesis may best be tested in a pragmatic applied clinical study, i.e. through the application of nebulized capsaicin in relevant clinical situations, as opposed to observational or experimental physiological studies.
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Affiliation(s)
- S T Kulnik
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, United Kingdom.
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