Palliative and End-of-Life Care for Patients With Cardiopulmonary Diseases

Selecky, Paul A.; Eliasson, Col Arn H.; Hall, Richard; Schneider, Roslyn F.; Varkey, Basil; McCaffree, D. R.

doi:10.1378/chest.128.5.3599

Cited by 141 publications

(80 citation statements)

References 74 publications

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“…The low rate of reporting a completed advance directive by adults with CF is consistent with other studies showing low rates of advance directive completion in the general population, [3][4][5]19,20 in patients following lung transplantation, 21 and in patients with progressive childhood diseases such as Duchenne's muscular dystrophy. 22 The low rate highlights the discontinuity between a patient thinking about ACP and completing a document for their medical record.…”

Section: Sawicki Et Al 1138supporting

confidence: 86%

“…3 The American College of Chest Physicians encourages proactive ACP among all patients with chronically progressive pulmonary disease. 4 Despite these recommendations, studies on ACP in both the general and chronically ill patient population have demonstrated a low rate of advance directive completion. 5 Although ACP discussions are advocated in adult CF care guidelines for all patients regardless of disease severity, 6 prior research on end-of-life issues in CF have mainly focused on processes and events at the time of death.…”

mentioning

confidence: 99%

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Advance Care Planning in Adults with Cystic Fibrosis

Sawicki

Dill

Asher

et al. 2008

Journal of Palliative Medicine

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Background: Because many patients with cystic fibrosis (CF) continue to survive into adulthood, discussion of end-of-life care decisions between clinicians and patients becomes a crucial part of CF adult care. Advance care planning (ACP) promotes alignment of patient care at the end of life with an individual's goals, however minimal research exists on ACP in CF. Methods: We surveyed adults enrolled in the Project on Adult Care in Cystic Fibrosis (PAC-CF). We assessed experiences with ACP processes and communication and sought to identify factors associated with completion of an advance directive. Results: The mean age of respondents (n ϭ 234) was 34 years and the mean forced expiratory volume in 1 second (FEV 1 ) was 64% predicted. Seventy-four percent reported that they had spoken to someone, generally a family member, about the care they would want if they became too ill to make decisions for themselves. However, only 30% reported completing an advance directive. Although 79% reported feeling comfortable talking to their clinician about ACP, only 28% said that their CF clinicians have asked about ACP. Having specific wishes about treatment decisions (odds ratio [OR] 7.8, 95% confidence interval [CI] 1.9-32.1) and reporting that a clinician had discussed ACP (OR 4.4, 95% CI 1.5-12.6) were significantly associated with reporting the completion of an advance directive. Discussion: Though the majority of adults with CF report thinking about and communicating with family about advance care wishes, only a minority report completing an advance directive. Few adults with CF report being asked about ACP by their clinicians. Formulating specific wishes and discussing ACP with a clinician are strongly associated with completing an advance directive. Efforts to improve clinician communication with CF adults around ACP are needed to ensure that discussion of advance directives becomes an integral component of adult CF care.

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Section: Sawicki Et Al 1138supporting

confidence: 86%

mentioning

confidence: 99%

Advance Care Planning in Adults with Cystic Fibrosis

Sawicki

Dill

Asher

et al. 2008

Journal of Palliative Medicine

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“…2,3 Although the prospect of lung transplantation provides hope to patients and their families, these patients are usually very symptomatic from their underlying disease. 3 Often, the severity of their symptom distress is an important factor driving the decision to list them for …”

mentioning

confidence: 99%

Barriers to Optimal Palliative Care of Lung Transplant Candidates

Colman

Curtis

Nelson³

et al. 2013

Chest

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“…Patients with COPD are at risk of ARF and recent advances in NIV use raise questions about the use of this technology in the palliative care setting [90,91]. Despite the fact that some previous guidelines did not mention it [92], NIV is being used increasingly as an alternative to ETI in end-stage symptomatic patients, especially to relieve dyspnoea [93][94][95][96][97]. Therefore, more recent guidelines have incorporated such a notion with the limitation that: ''As relief of dyspnoea with NIV may not relate to changes in arterial blood gases, it is appropriate to reassess the breathlessness experienced by patients receiving such ventilatory support at frequent intervals'' [98].…”

Section: Palliative and End-of-life Carementioning

confidence: 99%

Unusual applications of noninvasive ventilation

Ambrosino¹,

Guarracino²

2011

Eur Respir J

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The use of noninvasive ventilation (NIV) in acute hypercapnic respiratory failure, cardiogenic pulmonary oedema, acute lung injury/acute respiratory distress syndrome (ARDS), community-acquired pneumonia and weaning/post-extubation failure is considered common in clinical practice. Herein, we review the use of NIV in unusual conditions.Evidence supports the use of NIV during fibreoptic bronchoscopy, especially with high risks of endotracheal intubation (ETI), such as in immunocompromised patients. During transoesophageal echocardiography as well as in interventional cardiology and pulmonology, NIV can reduce the need for deep sedation or general anaesthesia and prevent respiratory depression induced by deep sedation. NIV may be useful after surgery, including cardiac surgery, and, with a lower level of evidence, in patients with pulmonary contusion.NIV should not be considered as an alternative to ETI in severe communicable airborne infections likely to progress to ARDS. NIV is being used increasingly as an alternative to ETI in end-stage symptomatic patients, especially to relieve dyspnoea. The role of assisted ventilation during exercise training in chronic obstructive pulmonary disease patients is still controversial.NIV should be applied under close monitoring and ETI should be promptly available in the case of failure. A trained team, careful patient selection and optimal choice of devices, can optimise outcome of NIV.

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Palliative and End-of-Life Care for Patients With Cardiopulmonary Diseases

Cited by 141 publications

References 74 publications

Advance Care Planning in Adults with Cystic Fibrosis

Advance Care Planning in Adults with Cystic Fibrosis

Barriers to Optimal Palliative Care of Lung Transplant Candidates

Unusual applications of noninvasive ventilation

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