33 What are the best settings and methods for recruitment into a randomised trial in severe breathlessness?

Abstract

Background Research interest is growing in using EEG-based tools, such as Bispectral Index (BIS) technology, to assess levels of sedation for palliative care patients. To date, little research has investigated using BIS in palliative care practice, but previous exploratory work for our I-CANCARE programme asked clinicians, patients, and relatives whether using BIS in palliative care would be acceptable in principle. Aim To explore the direct experiences and perceptions of palliative care patients, their relatives, and clinicians regarding BIS monitoring in a UK hospice. Methods We trialled the use of BIS with hospice inpatients, and then conducted semi-structured interviews with them, their relatives, and hospice clinicians. Interview transcripts were analysed following the framework method. Results Ten patients, two relatives, and ten clinicians participated in individual interviews. Most (as in our previous hypothetical study) considered BIS monitoring non-intrusive. Some patients commented that after the sensor had been applied to their foreheads they were 'not aware' of it. Patients and clinicians commented that, although noticeable, the BIS device and sensor were small and easily handled, and felt that the monitoring did not affect patients' daily routines, nor care activities. After trialling BIS monitoring, participants said that they would have no objections to BIS being used as part of routine care, provided that it was beneficial for patients. Conclusions Our participants perceived BIS technology as acceptable and feasible for monitoring hospice inpatients' consciousness levels. This indicates that further exploration of how this technology might contribute to palliative care practice would be appropriate, and valuable.

Dyspnea

“…К тому же ингибиторы обратного захвата серотонина повышают риск нежелательных явлений, включая пневмонию и увеличение летальности у больных ХОБЛ старшего возраста. Более перспективным является трициклический антидепрессант миртазапин, влияние которого на хроническую одышку в настоящее время активно изучается [70].…”

Chronic Obstructive Pulmonary Disease Combined With Interstitial Lung Disease

“…Recently, several antidepressants have been studied for symptomatic relief in patients with chronic lung diseases. Mirtazapine, a noradrenergic and specific serotonergic antidepressant, was effective in treating chronic breathlessness in a multicenter, randomized, placebo-controlled, double-blind, feasibility trial [101]. Ninety-five percent of patients had either COPD or ILD, and all patients had a Modified Medical Research Council score ≥ 3 at baseline.…”