Pandemic palliative care: beyond ventilators and saving lives

Abstract

KEY POINTS• The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic will likely strain our health care system beyond capacity, and palliative care services will be needed across many different care settings, including intensive care units, hospital wards, emergency departments and long-term care.

Virtual Reality as a Bridge in Palliative Care during COVID-19

“…1 The needs of those who are on their deathbeds are often overlooked, with the most vulnerable population such as the elderly, immunocompromised, often being disproportionately affected. 2 The act of dying alone is irrefutably traumatizing, aggravated by the fact that upon being diagnosed with COVID-19, patients often undergo rapid deterioration, giving them little or no chance to find closure with their loved ones before demise. 2 The potential psychological impact on loved ones can be complicated-ranging from grief and depression from acute loss to immense guilt for not being physically present, all of which may last a lifetime.…”

Soins de fin de vie pour les patients atteints d’un virus respiratoire extrêmement transmissible : implications pour la COVID-19

“…Limitations imposed by isolation to limit infection transmission, personal protective equipment (PPE), and restriction of visitors may impact the communication skills that we are all accustomed to using and may lead to pressures that can impact goals of care discussions. 3 In recent years, there has been considerable work on developing frameworks for discussing goals of care. The following frameworks share similar principles, and remain valid and unchanged in the setting of COVID-19 4,5 :…”

“…Canadian physicians working in critical care environments should familiarize themselves with provincial guidelines for capacity assessment and determination of the appropriate substitute decision-maker. 3,26,27 Standards of withdrawal of life support in a critical care setting…”

“…[33][34][35][36] While there are a range of presentations of COVID-19 ranging from arrhythmias to thrombosis, 20 severe COVID-19 has presented predominantly as a respiratory disease, 37,38 and providers caring for patients dying in this context should be particularly adept in the assessment and management of dyspnea. 3,[39][40][41] Suggestions regarding the logistics of WLSM are also contained in recently published Canadian guidelines. 28 The discontinuation of mechanical ventilation is a specific concern for patients dying with a highly transmissible respiratory virus.…”

Developing a Thai national critical-care allocation guideline during the COVID-19 pandemic: a rapid review and stakeholders’ consultation 

“…There have been extensive reports of inadequate supply of personal protective equipment for healthcare workers and shortages of intensive care beds and ventilators in many countries (3). The surplus in demand exceeding the availability of healthcare resources has led to the unavoidable rationing of medical equipment and interventions, notably critical care resources which are challenging to expand in a short time (3)(4)(5)(6)(7). As a result, several countries have been compelled to develop national resource allocation guides, speci c to COVID-19 and country context (8)(9)(10)(11)(12).…”