The known unknowns of assisted hydration at the end of life

Kingdon, Arjun; Spathis, Anna; Bowers, Ben; Barclay, Stephen

doi:10.12968/bjcn.2021.26.6.284

Cited by 1 publication

(1 citation statement)

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“…15 Decision-making surrounding hydration by hypodermoclysis in palliative care, should take into account the net clinical benefit from evidence applied to the individual situation in partnership with the person and/or their families. 16 The small number of clinical trials evaluate hypodermoclysis in more narrow clinical scenarios, and how these findings apply in real world settings where there is heterogeneity in both the clinical context and aims of therapy is less well characterised.…”

Section: Introductionmentioning

confidence: 99%

Investigating the benefits and harms of hypodermoclysis of patients in palliative care: A consecutive cohort study

et al. 2022

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Background: Palliative populations are at risk for dehydration which can cause discomfort, distress and cognitive symptoms. Subcutaneous hydration (‘hypodermoclysis’) has been used as an alternative administration route to the more invasive intravenous route, but research is lacking on its net clinical effects (harms and benefits) for palliative populations, particularly in real world settings. Aim: To quantify prospectively the net clinical effects of hypodermoclysis in palliative patients with advanced disease who required supplementary fluids. Design: Multisite, multinational consecutive cohort study. Setting/participants: Patients receiving hypodermoclysis in an inpatient palliative care setting. Results: Twenty sites contributed data for 99 patients, of which 88 had complete benefits and harms data. The most common primary target symptom for infusion was generalised weakness (18.2%), and the most common non-symptom indication was supplemental hydration (31.8%). Benefits were experienced in 33% of patients in their primary target symptom, and in any symptom in 56.8%. Harms were experienced in 38.7% of patients (42% at Grade 1). Benefits increased with higher performance status, while harms were more frequent in patients with lower performance status (Australia-modified Karnofsky performance status ⩽40). Patients in the terminal phase of their illness experienced the least benefit (15.4% in any indication only) and had more frequent harms (38%). Conclusions: Hypodermoclysis may improve certain symptoms in patients in palliative care but frequency of harms and benefits may differ at certain timepoints in the illness trajectory. Further research is needed to better delineate which patients will derive the most net clinical benefit from hypodermoclysis.

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Section: Introductionmentioning

confidence: 99%