Characteristics, Symptom Management, and Outcomes of 101 Patients With COVID-19 Referred for Hospital Palliative Care
Characteristics, Symptom Management, and Outcomes of 101 Patients With COVID-19 Referred for Hospital Palliative Care
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DOI：
10.1016/j.jpainsymman.2020.04.015
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发表时间：
2020-07-01
影响因子：
4.7
通讯作者：
Sleeman, Katherine E.
中科院分区：
文献类型：
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作者：
Lovell, Natasha;Maddocks, Matthew;Sleeman, Katherine E.
医院姑息治疗是新冠肺炎应对措施的重要组成部分，但缺乏数据。我们确定了101例确诊为新冠肺炎并转至医院姑息治疗的住院患者的症状负担、管理、治疗反应和结果。患者(男性，中位数[四分位数范围]，82[72e89]岁，Elixhauser共病指数6[2e10]，澳大利亚改良的Karnofsky功能状态20[10e20])最常被转诊为临终关怀或症状控制。从入院到转诊的平均[IQR]天为4[1e12]天。最常见的症状是呼吸困难(67例)、烦躁不安(43例)、嗜睡(36例)、疼痛(23例)和精神错乱(24例)。58名患者被开出皮下输液的处方。常用药物(中位剂量/24小时)为阿片类药物(吗啡10[5e30]mg；芬太尼100[100-200]微克；阿芬太尼500[150-1000]微克)和咪达唑仑(10[5-20]毫克)。输液被评估为至少有40/58名患者部分有效，而13名患者在复查前死亡。患者在姑息治疗团队下的平均时间为2[1-4]天，他们与患者、家人和临床医生进行了3[2-5]次接触。截至2020年3月30日，已有75名患者死亡；13名患者已出院返回团队、家庭或临终关怀；13名患者继续接受住院姑息治疗。姑息治疗是新冠肺炎应对措施的重要组成部分，团队必须迅速适应新的工作方式。呼吸困难和躁动很常见，但对阿片类药物和苯二氮卓类药物反应良好。皮下输液泵的可用性是至关重要的。随着新冠肺炎疫情的发展，制定姑息治疗的国际最低数据集将加快找到新问题的答案。(C)2020年美国临终关怀与姑息医学学会。爱思唯尔公司出版，版权所有。
Hospital palliative care is an essential part of the COVID-19 response but data are lacking. We identified symptom burden, management, response to treatment, and outcomes for a case series of 101 inpatients with confirmed COVID-19 referred to hospital palliative care. Patients (64 men, median [interquartile range {IQR}] age 82 [72e89] years, Elixhauser Comorbidity Index 6 [2e10], Australian-modified Karnofsky Performance Status 20 [10e20]) were most frequently referred for end-of-life care or symptom control. Median [IQR] days from hospital admission to referral was 4 [1e12] days. Most prevalent symptoms (n) were breathlessness (67), agitation (43), drowsiness (36), pain (23), and delirium (24). Fifty-eight patients were prescribed a subcutaneous infusion. Frequently used medicines (median [range] dose/24 hours) were opioids (morphine, 10 [5e30] mg; fentanyl, 100 [100-200] mcg; alfentanil, 500 [150-1000] mcg) and midazolam (10 [5-20] mg). Infusions were assessed as at least partially effective for 40/58 patients, while 13 patients died before review. Patients spent a median [IQR] of 2 [1-4] days under the palliative care team, who made 3 [2-5] contacts across patient, family, and clinicians. At March 30, 2020, 75 patients had died; 13 been discharged back to team, home, or hospice; and 13 continued to receive inpatient palliative care. Palliative care is an essential component to the COVID-19 response, and teams must rapidly adapt with new ways of working. Breathlessness and agitation are common but respond well to opioids and benzodiazepines. Availability of subcutaneous infusion pumps is essential. An international minimum data set for palliative care would accelerate finding answers to new questions as the COVID-19 pandemic develops. (C) 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.