Symptom Management and Supportive Care of Serious COVID-19 Patients and their Families in India

Abstract

Coronavirus disease-19 (COVID-19) pandemic is causing a worldwide humanitarian crisis. Old age, comorbid conditions, end-stage organ impairment, and advanced cancer, increase the risk of mortality in serious COVID-19. A subset of serious COVID-19 patients with serious acute respiratory illness may be triaged not to receive aggressive intensive care unit (ICU) treatment and ventilation or may be discontinued from ventilation due to their underlying conditions. Those not eligible for aggressive ICU measures should receive appropriate symptom management. Early warning scores (EWS), oxygen saturation, and respiratory rate, can facilitate categorizing COVID-19 patients as stable, unstable, and end of life. Breathlessness, delirium, respiratory secretions, and pain, are the key symptoms that need to be assessed and palliated. Palliative sedation measures are needed to manage intractable symptoms. Goals of care should be discussed, and advance care plan should be made in patients who are unlikely to benefit from aggressive ICU measures and ventilation. For patients who are already in an ICU, either ventilated or needing ventilation, a futility assessment is made. If there is a consensus on futility, a family meeting is conducted either virtually or face to face depending on the infection risk and infection control protocol. The family should be sensitively communicated about the futility of ICU measures and foregoing life-sustaining treatment. Family meeting outcomes are documented, and consent for foregoing life-sustaining treatment is obtained. Appropriate symptom management enables comfort at the end of life to all serious COVID-19 patients not receiving or not eligible to receive ICU measures and ventilation. How to cite this article: Salins N, Mani RK, Gursahani R, Simha S, Bhatnagar S. Symptom Management and Supportive Care of Serious COVID-19 Patients and their Families in India. Indian J Crit Care Med 2020;24(6):435–444.

Advanced Care Planning (ACP) in the early phase of COVID-19: A rapid review of the practice and policy lessons learned

“…PRS indicated increasing emphasis on ACP for vulnerable groups, such as older adults (Berning et al, 2021; Biswas et al, 2020; Farrell, Ferrante, et al, 2020; Farrell, Francis, et al, 2020; Gilissen et al, 2020; Kotze & Roos, 2020; Kuzuya et al, 2020; Rivet et al, 2020; Valeri et al, 2020; Vipperman et al, 2021; West et al, 2021; Ye et al, 2021), and high-risk groupswith pre-existing life-limiting and/or chronic conditions, such as HIV (Nguyen et al, 2021), cancer or organ failure (Biswas et al, 2020; Rivet et al, 2020; Salins et al, 2020), cardiovascular/cerebrovascular disease (Liao et al, 2020) or severe mental illness (Kotze & Roos, 2020). These recommendations were supported by commentaries (Reja et al, 2020) (Kluger et al, 2020), (Prost et al, 2021).…”

“…ACP was identified as enablingfairer and more transparent resource allocation during periods of constraint, potentially reducing unnecessary life-sustaining treatments and streamlining the use of intensive care resources (Farrell, Francis, et al, 2020; Gupta et al, 2020; Liao et al, 2020; Salins et al, 2020). This was seen to alleviate the need for healthcare rationing, by avoiding aggressive treatment for those who do not want it, engaging patients in shared-decision making and avoiding blanket decisions based on age or comorbidity.…”

“…Two main lessons surfaced from this rapid review. First, the prevalence and clarity of goals of care discussions were often touched on as a priority issue for patient management, prevention of unwanted (non-goal-aligned) care, or transfer decisions, across the range of study types ((Bolt et al, 2021; Burke et al, 2020; Gupta et al, 2021; Kuntz et al, 2020; Liao et al, 2020; Piscitello et al, 2021; Salins et al, 2020; Vipperman et al, 2021)(Nguyenet al, 2021). Next, frequent references to online tools or resources (Auriemma et al, 2020; Gaur et al, 2020; Paladino et al, 2021; Portz et al, 2020; Selman L et al, 2020) and virtual learning for clinicians and families including online family meetings (Gupta et al, 2021; Janssen et al, 2020; Kuntz et al, 2020; Mills et al, 2021; Piscitello et al, 2021; Rabow et al, 2021; Smith et al, 2020), reflect rapid embracing of innovative approaches to facilitate ACP completion and circumvent face-to-face interactions.…”

Determining the Spiritual Care Requirements and Death Anxiety Levels of Patients Diagnosed with COVID-19 in Turkey

“…This is because spirituality has a strong effect on the beliefs, attitudes, emotions and behaviors of a person (Olson et al, 2015 ). Being able to use this effect in a positive direction and improving both the physical and mental statuses of patients may be possible by providing spiritual care in a quality manner (Salins et al, 2020 ).…”

Preparedness and capacity of indian palliative care services to respond to the COVID-19 pandemic: An online rapid assessment survey

“…[ 21 ] Indian-specific guidelines are available for the supportive care and symptom management of severe COVID-19 cancer patients and their families. [ 22 ] However, preparedness and capacity within palliative care services to fulfill their essential role in the COVID-19 pandemic have not been assessed.…”