Eine “Epidemiologie” zum Stellenwert von oral appliziertem Morphium als Therapieform des schwergradigen Lungenemphysems vom Pink-Puffer-Typ

Schönhofer, Bernd; Suchi, Stefan; Haidl, P.; Köhler, Dieter

doi:10.1007/pl00002212

Cited by 5 publications

(1 citation statement)

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“…Es gehört zum Inhalt des ärztlichen In− formationsgespräches, neben der Beatmung alternative Thera− pieoptionen zur Linderung von schwerer Dyspnoe, wie z. B. Opia− te, Sauerstoff und Physiotherapie zur Sekretmobilisation zu er− läutern[12]. Diese Themen lassen sich allerdings nicht in einem einmaligen Gespräch erschöpfend abhandeln, so dass der Dialog unter besonderer Berücksichtigung der jeweils neuen Entwick− lungen fortgesetzt werden muss.Es ist darüber hinaus anzustre− ben, dass auch Ärzte und Institutionen aus der direkten Umge− bung des Patienten in diesen Prozess integriert werden.…”

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Ethische Betrachtungen zur Beatmungsmedizin unter besonderer Berücksichtigung des Lebensendes

Schönhofer

Köhler²,

Kutzer³

2006

Pneumologie

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Invasiveness of interventions, complexity of diseases and patients' age are increasing in intensive care medicine. Ethical and legal issues are particularly challenging at the end of life of critically ill patients. At the borderline between intensive care and palliative medicine a significant amount of patients suffer from respiratory failure. Modern modes of mechanical ventilation may be able to improve ventilation and quality of life. On the other hand they may oppose a dignified death at the end of a long lasting chronic disease and e. g. prolong the suffering. In contrast to endotracheal intubation and invasive mechanical ventilation NIV enables patients to participate in the decision making process. While under normal circumstances, ethical standards dictate that patients themselves participate in the medical decision making process. For several reasons this is not always possible in intensive care medicine. However, chronically ill patients should get information from experts already at an early stage of the disease, go through a shared decision process and declare their will concerning interventions of intensive care medicine, e. g. mechanical ventilation. With respect to ethical and legal aspects of end of life this paper deals with chances of mechanical ventilation, including its withdrawal and withholding.

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Ethische Betrachtungen zur Beatmungsmedizin unter besonderer Berücksichtigung des Lebensendes

Schönhofer

Köhler²,

Kutzer³

2006

Pneumologie

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Symptomatic Therapy of Dyspnea with Strong Opioids and Its Effect on Ventilation in Palliative Care Patients

Clemens

Klaschik

2007

Journal of Pain and Symptom Management

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This study assessed the effect of opioid treatment on ventilation in dyspneic palliative care patients who received symptomatic treatment with strong opioids. The assessments measured changes in peripheral arterial oxygen saturation (SaO(2)), transcutaneous arterial pressure of carbon dioxide (tcPCO(2)), respiratory rate (f), and pulse rate (PF) during the titration phase with morphine or hydromorphone. The aims of the study were to verify the efficacy of opioids for the management of dyspnea, assess the effect on ventilation, and show whether nasal O(2) insufflation before opioid application leads to a decrease in the intensity of dyspnea. Eleven patients admitted to our palliative care unit were included in this prospective, nonrandomized trial. At admission, all patients suffered from dyspnea. tcPCO(2), SaO(2), and PF were measured transcutaneously by means of a SenTec Digital Monitor (SenTec AG, Switzerland). During O(2) insufflation, the intensity of dyspnea did not change. In contrast, the opioid produced a significant improvement in the intensity of dyspnea (P=0.003). Mean f decreased as early as 30 minutes after the first opioid administration, declining from 41.8+/-4.7 (35.0-50.0) to 35.5+/-4.2 (30.0-40.0), and after 90 minutes, to 25.7+/-4.5 (20.0-32.0) breaths/min. Other monitored respiratory parameters, however, showed no significant changes. There was no opioid-induced respiratory depression.

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Leitlinie der Deutschen Atemwegsliga und der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD)

et al. 2007

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Eine “Epidemiologie” zum Stellenwert von oral appliziertem Morphium als Therapieform des schwergradigen Lungenemphysems vom Pink-Puffer-Typ

Abstract: In patients with severe emphysema from pink puffer type a trial with morphine is justified. In particular the beneficial effect on dyspnea in the responder group and the acceptable rate of side effects underline this strategy.

Cited by 5 publications

References 20 publications

Ethische Betrachtungen zur Beatmungsmedizin unter besonderer Berücksichtigung des Lebensendes

Ethische Betrachtungen zur Beatmungsmedizin unter besonderer Berücksichtigung des Lebensendes

Symptomatic Therapy of Dyspnea with Strong Opioids and Its Effect on Ventilation in Palliative Care Patients

Leitlinie der Deutschen Atemwegsliga und der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD)

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