Palliation of Dyspnea in pediatrics

Robinson, Walter M.

doi:10.1177/1479972312452439

Cited by 11 publications

(12 citation statements)

References 30 publications

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“…The intervention was classified as having provided effective relief, partial relief or no relief of symptoms, according to nursing or physician notes or an assessment scale (before and 10 min after the protocol medication was administered). Given there is no validated scale for dyspnea in the pediatric palliative care population [9], the modified Borg Scale (1 to 10) was used in this study [10]. To ensure uniformity, nurses were responsible for recording the score in every case; the same nurse would rate the patient’s dyspnea both before and after administration of the OPD medications.…”

Section: Methodsmentioning

confidence: 99%

Clinical Use of an Order Protocol for Distress in Pediatric Palliative Care

et al. 2019

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Several children receiving palliative care experience dyspnea and pain. An order protocol for distress (OPD) is available at Sainte-Justine Hospital, aimed at alleviating respiratory distress, pain and anxiety in pediatric palliative care patients. This study evaluates the clinical use of the OPD at Sainte-Justine Hospital, through a retrospective chart review of all patients for whom the OPD was prescribed between September 2009 and September 2012. Effectiveness of the OPD was assessed using chart documentation of the patient’s symptoms, or the modified Borg scale. Safety of the OPD was evaluated by measuring the time between administration of the first medication and the patient’s death, and clinical evolution of the patient as recorded in the chart. One hundred and four (104) patients were included in the study. The OPD was administered at least once to 78 (75%) patients. A total of 350 episodes of administration occurred, mainly for respiratory distress (89%). Relief was provided in 90% of cases. The interval between administration of the first protocol and death was 17 h; the interval was longer in children with cancer compared to other illnesses (p = 0.02). Data from this study support the effectiveness and safety of using an OPD for children receiving palliative care.

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Section: Methodsmentioning

confidence: 99%

Clinical Use of an Order Protocol for Distress in Pediatric Palliative Care

et al. 2019

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“…Equally important is that one can quickly choose to discontinue therapy if it proves ineffective or is no longer desired, unlike chronic PPV via tracheostomy. 12…”

Section: Cuirass Ventilation Use In Palliative Medicinementioning

confidence: 99%

Cuirass Ventilation: An Alternative Home-Based Modality for Chronic Respiratory Failure

Onweni

Rashid

Goswami

et al. 2019

Home Health Care Management & Practice

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The biphasic cuirass ventilation (BCV) device is an alternative respiratory support device for patients with chronic respiratory failure. Considered by some a “forgotten” mode of supportive ventilation, the device is portable, lightweight, and easy to operate. Biphasic cuirass ventilation can also be used to rapidly resuscitate patients in acute respiratory distress and requires minimal technical skill to operate. Biphasic cuirass ventilation can be employed by the patient’s caregiver in the home setting, making it a viable alternative to other forms of mechanical ventilation (e.g., BiPAP) for patients enrolled in home hospice or palliative care. The article reviews current knowledge and aims to enhance awareness and encourage further study about cuirass ventilation, particularly with regard to its use in treating patients in the palliative care setting and in the home.

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“…The most effective treatment of RD is the identification and therapy of underlying causes. However, this approach is frequently limited when no specific cause is apparent or no effective treatment at hand [ 22 ]. In this situation, symptomatic treatment is warranted.…”

Section: Introductionmentioning

confidence: 99%

“…In this situation, symptomatic treatment is warranted. Non-pharmacological approaches include physiotherapy, management of secretions, fans to blow in the face, psychological and behavioral therapy and (noninvasive) positive pressure ventilation [ 1 , 22 , 23 ]. Pharmacological treatment mainly consists of opioids and anxiolytics [ 1 , 22 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

“…Non-pharmacological approaches include physiotherapy, management of secretions, fans to blow in the face, psychological and behavioral therapy and (noninvasive) positive pressure ventilation [ 1 , 22 , 23 ]. Pharmacological treatment mainly consists of opioids and anxiolytics [ 1 , 22 , 24 ]. In the pharmacological treatment of RD in adults, opioids are used frequently with good evidence for the oral and parenteral route [ 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

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Intranasal fentanyl for respiratory distress in children and adolescents with life-limiting conditions

2018

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BackgroundRespiratory distress is one of the most common and frightening symptoms of children with life-limiting conditions. Because treatment of the underlying cause is frequently impossible or insufficient, in many children, symptomatic treatment is warranted. The purpose of this study was to describe the circumstances of the use of intranasal fentanyl in an acute attack of respiratory distress (AARD) in children receiving palliative care, as well as to describe outcomes and adverse events after its use.MethodsChildren and adolescents treated in a pediatric palliative unit or attended by a specialized home care team between 2010 and 2016 were included in this study. A retrospective chart review was conducted of those who were treated with intranasal fentanyl for an AARD.ResultsDuring the study period 16 children (0.5–18.6 years) with various life-limiting conditions were treated with intranasal fentanyl for AARD. In total, 70 AARDs were analyzed. In 74% of all AARDs, a single dose of intranasal fentanyl was used. Frequent causes for an AARD were excessive secretions and acute respiratory infection. The median starting dose of intranasal fentanyl was 1.5 μg/kg body weight. Labored breathing (96%), tachypnea (79%) and related suffering (97%) improved after treatment. An adverse event occurred in one child.ConclusionsIntranasal fentanyl may be a safe and effective medication for the treatment of acute attacks of respiratory distress in children with life-limiting conditions. However, prospective studies with larger sample sizes and a control group are needed to validate these findings.

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Palliation of Dyspnea in pediatrics

Cited by 11 publications

References 30 publications

Clinical Use of an Order Protocol for Distress in Pediatric Palliative Care

Clinical Use of an Order Protocol for Distress in Pediatric Palliative Care

Cuirass Ventilation: An Alternative Home-Based Modality for Chronic Respiratory Failure

Intranasal fentanyl for respiratory distress in children and adolescents with life-limiting conditions

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