Is There a Higher Risk of Respiratory Depression in Opioid-Naïve Palliative Care Patients during Symptomatic Therapy of Dyspnea with Strong Opioids?

Abstract

No higher risk of respiratory depression and increase in tcpaCO2 in opioid-naïve palliative care patients, compared to patients pretreated with strong opioids, during symptomatic therapy of dyspnea with strong opioids could be found.

Use of oxygen and opioids in the palliation of dyspnoea in hypoxic and non-hypoxic palliative care patients: a prospective study

“…A previous study [14] compared the efficacy of opioids to nasal O 2 insufflation for the management of dyspnoea and assessed the effects of opioids on ventilation, but not in hypoxic patients. In a further study, we investigated whether or not there is a higher risk of respiratory depression in opioid-naïve palliative care patients than in patients pre-treated with strong opioids during symptomatic therapy of dyspnoea [16]. Due to the poor health status of the patients in our trial, it was not possible to do formal exercise testing for most of the patients, this is why all measurements were at rest.…”

“…With regard to management of dyspnoea, there is an ongoing controversial debate about the role of oxygen [38] and the risks of respiratory depression during symptomatic therapy of dyspnoea with opioids in palliative care patients [2,4,5,42], above all, in hypoxic and opioid-naïve patients and in patients pre-treated with strong opioids [16]. The following definition is important when prescribing oxygen therapy [44]: short-burst oxygen therapy (intermittent oxygen therapy) is intermittent use of oxygen for the relief of breathlessness, before exercise or for recovery after exercise.…”

Opioids for refractory dyspnea

“…However, results of clinical studies do not support this consideration. In different prospective, but nonrandomized studies, Clemens et al found significant decreases in the intensity of dyspnea and respiratory rate with initial opioid treatment in patients receiving palliative care, but no evidence of respiratory depression [65,66]. Chan et al found that higher doses of opioids and anxiolytic medications used in withdrawal of life support were not associated with a decreased time from withdrawal of life support to death [67].…”

Importance of the correct diagnosis of opioid-induced respiratory depression in adult cancer patients and titration of naloxone

“…6 In patients receiving opioids for the relief of dyspnoea, there was no decrease in the oxygen saturation or increase in the CO 2 levels. 7,8 The preservation of oxygen saturations might be due to an increase in tidal volume and conservation of minute ventilation. 9,10 Thus, although respiratory rate is decreased, the overall ventilation and gas exchange remains stable, as do the oxygen saturations.…”