Effect of Parenteral Hydration Therapy Based on the Japanese National Clinical Guideline on Quality of Life, Discomfort, and Symptom Intensity in Patients With Advanced Cancer

Yamaguchi, Takashi; Morita, Tatsuya; Shinjo, Takuya; Inoue, Satoshi; Takigawa, Chizuko; Aruga, Etsuko; Tani, Kazuhiro; Hara, Takashi; Tamura, Yoichiro; Suga, Akihiko; Adachi, Seiji; Katayama, Hideki; Osaka, Iwao; Saito, Yoshiyuki; Nakajima, Nobuhisa; Higashiguchi, Takashi; Hayashi, Toshimitsu; Okabe, Takeshi; Kohara, Hiroyuki; Tamaki, Tomohiro; Chinone, Yoshikazu; Aragane, Hideki; Kanai, Yoshiaki; Tokura, Natsuki; Yamaguchi, Takuhiro; Asada, Takashi; Uchitomi, Yosuke

doi:10.1016/j.jpainsymman.2011.06.028

Cited by 38 publications

(35 citation statements)

References 21 publications

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“…Previous studies have found a tendency of higher prevalence with more hydration 13 15. Our results are in accordance with those; the prevalence was higher in the PF groups for all time frames, although significant only when comparing PF administration the last week with symptom for the last 24 h (table 3).…”

Section: Discussionsupporting

confidence: 92%

“…In that study, no statistically significant difference in respiratory distress was found between patients receiving small (<1 L) and large (>1 L) daily volumes of fluid in the last weeks of life 13. Our results are not consistent with theirs, but the differences are also probably due to different research methods (eg, their study group did not have a matched control group) 13.…”

Section: Discussioncontrasting

confidence: 81%

“…We have found one more previous study that used dyspnoea (respiratory distress) as an outcome when studying hydration therapy in palliative patients 13. In that study, no statistically significant difference in respiratory distress was found between patients receiving small (<1 L) and large (>1 L) daily volumes of fluid in the last weeks of life 13.…”

Section: Discussionmentioning

confidence: 97%

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Association between parenteral fluids and symptoms in hospital end-of-life care: an observational study of 280 patients

Fritzson

Tavelin

Axelsson

2013

BMJ Support Palliat Care

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 81%

Section: Discussionmentioning

confidence: 97%

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Association between parenteral fluids and symptoms in hospital end-of-life care: an observational study of 280 patients

Fritzson

Tavelin

Axelsson

2013

BMJ Support Palliat Care

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“…4,6,15 One recent study found no relationship between parenteral fluids and development of death rattle, 5 although guidelines still recommend reducing fluids. 16 Pharmacological interventions are routinely used: palliative care texts invariably advocate the off-label use of anticholinergic medications for the treatment of death rattle. 17,18 Research on these pharmacological interventions is more robust but still fails to provide compelling evidence for effective treatment that changes the natural history of the clinical presentation.…”

Section: Significancementioning

confidence: 99%

The Death Rattle Dilemma

Fielding¹,

Long²

2014

Journal of Hospice & Palliative Nursing

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Death rattle, defined as the noise created by the flow of air through secretions in the upper respiratory tract, is a well-known phenomenon associated with the dying process. The use of anticholinergics is standard practice in hospice and palliative care, yet despite a growing number of quality clinical trials, there is still no compelling scientific evidence that our interventions for death rattle are effective. Studies to date have focused on antisecretory agents, primarily anticholinergics, with mixed results and variable interpretations. Recent placebo-controlled data suggest that death rattle may tend to diminish over time without medication. Objective measurements of patient distress indicate that dying patients experience very low levels of respiratory distress with or without death rattle. While treatment is often initiated based on the perceived distress of family members, emerging qualitative data suggest that death rattle is not always distressing to family and caregivers. Our current approach to death rattle presents a clinical and ethical dilemma; a better understanding of the range of responses and interpretations will allow nurses to frame the discussion of death rattle more effectively and help to guide care. More research is needed into nonpharmacologic, particularly communication-based, interventions for death rattle. KEYWORDSanticholinergic, communication, death rattle, dying, symptom management Case StudyMr E. was 66 years old with advanced gastric lymphoma and was dying at home, being cared for by his family. He was somnolent, but his respirations were unlabored, and lung sounds were clear. The hospice nurse educated his family on the signs and symptoms of active dying and the use of comfort medications, including 1% atropine eye drops to be given sublingually as needed for respiratory secretions. SIGNIFICANCEAlternately referred to in the literature as terminal congestion, retained secretions, noisy breathing, and respiratory tract secretions, death rattle is well known as a phenomenon associated with the dying process. Although the term death rattle may seem macabre, it is a pragmatic expression for a common occurrence at end of life and has the advantage of being both descriptive and widely recognizable. The varied terminology reflects a divergent body of research, the cumulative results of which have yet to define a criterion standard of treatment. This is due in part not only to inconsistent terminology, but also to the variable quality and conflicting findings between studies. 1 Despite barriers to research in dying patients, there is growing evidence to suggest a lack of utility of our treatments for death rattle. 2-6 This is especially important in light of research indicating that treatment is often given to alleviate the distress of family and caregivers, including health care professionals, while those who hear it are not always distressed by the sound. 7,8 In fact, objective measures indicate low levels of respiratory distress in dying patients and no difference in distress betwee...

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“…Increased fluid and metabolic loading causes discomfort, edema, and shortness of breath in these patients. [10][11][12] In end-of-life care, providing small amounts fluids or withholding total parenteral nutrition (TPN) to patients with terminal cancer is considered to be acceptable because of alleviation of symptoms or lack of evidence for benefits. 11,13 Nevertheless, withholding or withdrawing ANH conflicts with the idea that providing ANH is part of basic patient care.…”

mentioning

confidence: 99%

Factors Influencing Intensive Care Unit Nurses’ Behavioral Intentions Regarding Providing Artificial Nutrition and Hydration

Lou

2015

Journal of Hospice & Palliative Nursing

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Effect of Parenteral Hydration Therapy Based on the Japanese National Clinical Guideline on Quality of Life, Discomfort, and Symptom Intensity in Patients With Advanced Cancer

Abstract: Guideline-based parenteral hydration therapy contributed to maintaining global QoL and provided satisfaction and a feeling of benefit without increasing discomfort and worsening symptoms and fluid retention signs in patients with advanced cancer.

Cited by 38 publications

References 21 publications

Association between parenteral fluids and symptoms in hospital end-of-life care: an observational study of 280 patients

Association between parenteral fluids and symptoms in hospital end-of-life care: an observational study of 280 patients

The Death Rattle Dilemma

Factors Influencing Intensive Care Unit Nurses’ Behavioral Intentions Regarding Providing Artificial Nutrition and Hydration

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