Dying With Dyspnea in the Hospital

Morris, Deborah; Galicia-Castillo, Marissa

doi:10.1177/1049909115604140

Cited by 10 publications

(10 citation statements)

References 16 publications

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“…Despite the immense resources devoted to the monitoring and care of ICU patients, the relatively high prevalence of this marker of distress during the transition to comfort measures is surprising but consistent with prior estimates. 30,67 A small study of 32 terminally extubated patients in a neurologic ICU reported a 59% rate of labored breathing. 30 Apart from the small sample size of the study, the assessment of labored breathing is not fully standardized and may have led to biased estimates.…”

Section: Discussionmentioning

confidence: 99%

“…Others have estimated dyspnea rates of 34% among terminally extubated patients. 30,67 Previous evaluations of the use of anticipatory dosing of opiates in the setting of PVW have yielded unclear results. Two studies found that anticipatory dosing was not associated with earlier time to death, but the investigators did not examine symptom control or compare it with reactive dosing.…”

Section: Discussionmentioning

confidence: 99%

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Incidence and Risk Model Development for Severe Tachypnea Following Terminal Extubation

Fehnel

Hoz

Celi

et al. 2020

Chest

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The goal of this study was to measure the rate of severe tachypnea as a proxy for dyspnea and to identify characteristics associated with episodes of tachypnea. STUDY DESIGN AND METHODS: This study assessed a retrospective cohort of ICU patients from 2008 to 2012 mechanically ventilated at a single academic medical center who underwent PVW. The primary outcome of at least one episode of severe tachypnea (respiratory rate > 30 breaths/min) within 6 h after PVW was measured by using detailed physiologic and medical record data. Multivariable logistic regression was used to examine the association between patient and treatment characteristics with the occurrence of a severe episode of tachypnea post extubation. RESULTS: Among 822 patients undergoing PVW, 19% and 30% had an episode of severe tachypnea during the 1-h and 6-h postextubation period, respectively. Within 1 h postextubation, patients with the following characteristics were more likely to experience tachypnea: no pre-extubation opiates (adjusted OR [aOR], 2.08; 95% CI, 1.03-4.19), lung injury (aOR, 3.33; 95% CI, 2.19-5.04), Glasgow Coma Scale score > 8 (aOR, 2.21; 95% CI, 1.30-3.77), and no postextubation opiates (aOR, 1.90; 95% CI, 1.19-3.00). INTERPRETATION: Up to one-third of ICU patients undergoing PVW experience severe tachypnea. Administration of pre-extubation opiates (anticipatory dosing) represents a key modifiable factor that may reduce poor symptom control.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Model Development for Severe Tachypnea Following Terminal Extubation

Fehnel

Hoz

Celi

et al. 2020

Chest

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“…Morris and Galicia-Castillo 20 reported that, despite national guidelines, health-care providers still do not recognize dyspnea and do not optimally treat dyspnea in the final 24 hours of life, and few orders described treatment specifically for dyspnea. This report also demonstrated that patients with palliative care consultations more often received opioids, and opioid orders more specified treatment of dyspnea at the end of life.…”

Section: Discussionmentioning

confidence: 99%

Opioids for Relief of Dyspnea Immediately Before Death in Patients With Noncancer Disease: A Case Series Study

Murakami

2019

Am J Hosp Palliat Care

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Background: Dyspnea is commonly found in most conditions among patients with progressive noncancer disease. Objective: To clarify the effectiveness and safety of opioid administration for the treatment of dyspnea immediately before death in patients with noncancer disease. Methods: A retrospective case-series study involving 13 consecutive terminally ill patients who were near death and diagnosed with noncancer disease, and had refractory dyspnea and received opioid therapy, was performed. The authors investigated the route of administration, period, dosage of opioids, intensity of dyspnea—scored according to the Japanese version of the Support Team Assessment Schedule—and clinical course from a review of medical records. Results: The mean age of the patients was 86.5 ± 7.6years (range: 72-98years). The primary causes of dyspnea that led to opioid administration were heart failure (n = 10) and respiratory failure (n = 3). Oxycodone was used in one patient who experienced a complication of chronic renal failure; morphine was used in the other 12 patients. The route of opioid administration was continuous infusions in 11 patients, suppository in one, and oral administration in one. The final dose of oral morphine equivalents was 20.1 ± 8.1 mg/d (range: 5-36 mg [median: 18 mg]). All patients improved in symptom score after opioid administration. The score was significantly decreased from 3.2 ± 0.7 at the beginning of opioid administration to 1.2 ± 0.6 at final estimation ( P < .001). No severe adverse events occurred. Conclusions: Low-dose opioid administration in patients with terminally ill noncancer improved dyspnea and occurred no severe adverse events.

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“…Patients with advanced COPD or ILD typically suffer from severe dyspnea, [1][2][3] which increases with approaching death and is associated with impaired quality of life. [4][5][6] In addition to dyspnea, patients with COPD and ILD suffer frequently from other symptoms, such as fatigue, weight loss, depression and anxiety, further impairing their quality of life. [7] Centers managing chronic respiratory insu ciency in patients with COPD or ILD commonly screen for dyspnea as a target of therapy.…”

Section: Introductionmentioning

confidence: 99%

Dyspnea is associated with overall symptom burden in patients with chronic respiratory insufficiency

Rantala¹,

Leivo-Korpela

Lehto

et al. 2020

Preprint

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Objective Patients with chronic respiratory insufficiency suffer from many symptoms together with dyspnea. We evaluated the association of dyspnea with other symptoms in patients with chronic respiratory insufficiency due to chronic obstructive pulmonary disease or interstitial lung disease. Results This retrospective study included 101 patients. Dyspnea was assessed with modified Medical Research Council dyspnea questionnaire (mMRC) and other symptoms with Edmonton Symptom Assessment System (ESAS) and Depression Scale (DEPS). Patients with mMRC 4 (most severe dyspnea) compared to those with mMRC 0–3 reported higher median (IQR) symptom scores on ESAS in e.g. dry mouth (7.0 (4.0–8.0) vs. 3.0 (1.0–6.0), P < 0.001), tiredness (6.0 (3.0–7.0) vs. 3.0 (1.0–5.0), P < 0.001) and anxiety (3.0 (0.0-5.5) vs. 1.0 (0.0–3.0), P = 0.007). Patients with mMRC 4 were more likely to reach the DEPS threshold for depression compared to those with mMRC 0–3 (42.1% vs. 20.8%, P = 0.028). In conclusion, patients with chronic respiratory insufficiency need comprehensive symptom screening with relevant treatment, as they suffer from many severe symptoms worsening with increased dyspnea.

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Dying With Dyspnea in the Hospital

Cited by 10 publications

References 16 publications

Incidence and Risk Model Development for Severe Tachypnea Following Terminal Extubation

Incidence and Risk Model Development for Severe Tachypnea Following Terminal Extubation

Opioids for Relief of Dyspnea Immediately Before Death in Patients With Noncancer Disease: A Case Series Study

Dyspnea is associated with overall symptom burden in patients with chronic respiratory insufficiency

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