COVID-19 and Hospital Palliative Care - A service evaluation exploring the symptoms and outcomes of 186 patients and the impact of the pandemic on specialist Hospital Palliative Care
COVID-19 and Hospital Palliative Care - A service evaluation exploring the symptoms and outcomes of 186 patients and the impact of the pandemic on specialist Hospital Palliative Care
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DOI：
10.1177/0269216320949786
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发表时间：
2020-08-14
影响因子：
4.4
通讯作者：
McKeown, Alistair
中科院分区：
文献类型：
--
作者：
Hetherington, Lucy;Johnston, Bridget;McKeown, Alistair
背景：因 COVID-19 住院的患者发病率和死亡率增加，这需要医院专业姑息治疗团队的广泛参与。评估对有效症状管理需求激增的反应，可以加强在这一患者群体中提供姑息治疗。目标：描述转诊接受姑息治疗的住院 COVID-19 阳性患者的症状概况、症状管理要求和结果，并将 COVID-19 的姑息治疗需求与 2019 年的“典型”病例进行背景分析。设计：基于患者记录的回顾性队列审查进行服务评估。设置/参与者：美国的一个大型卫生委员会苏格兰。收集了 2020 年 3 月 30 日至 4 月 26 日期间转诊至医院姑息治疗团队的所有 COVID-19 阳性患者的人口统计数据、患者症状、用于症状控制的药物/剂量以及患者结果。结果：我们的 COVID-19 队列包括 186 名患者（占所有转诊患者的 46%）。呼吸困难和烦躁是最常见的症状（每位患者平均有 2 个症状）。 75%的患者接受了持续皮下输注以控制症状，对78.6%的患者有效。与“典型”病例相比，COVID-19 队列的病例处理时间较短（中位 2 天与 5 天；p < 0.001），并且死亡率较高（80.6% vs 30.3%；p < 0.001）。 COVID-19 队列取代了“典型”病例量；转诊总数并未增加。结论：转诊接受姑息治疗的住院 COVID-19 阳性患者的预后可能较短，与“典型”病例量不同，并且主要患有呼吸困难和烦躁。使用标准剂量的阿片类药物和苯二氮卓类药物可以有效控制此类症状。
Background: Patients hospitalised with COVID-19 have increased morbidity and mortality, which requires extensive involvement of specialist Hospital Palliative Care Teams. Evaluating the response to the surge in demand for effective symptom management can enhance provision of Palliative Care in this patient population.Aim: To characterise the symptom profile, symptom management requirements and outcomes of hospitalised COVID-19 positive patients referred for Palliative Care, and to contextualise Palliative Care demands from COVID-19 against a 'typical' caseload from 2019.Design: Service evaluation based on a retrospective cohort review of patient records.Setting/participants: One large health board in Scotland. Demographic data, patient symptoms, drugs/doses for symptom control, and patient outcomes were captured for all COVID-19 positive patients referred to Hospital Palliative Care Teams between 30th March and 26th April 2020.Results: Our COVID-19 cohort included 186 patients (46% of all referrals). Dyspnoea and agitation were the most prevalent symptoms (median 2 symptoms per patient). 75% of patients were prescribed continuous subcutaneous infusion for symptom control, which was effective in 78.6% of patients. Compared to a 'typical' caseload, the COVID-19 cohort were on caseload for less time (median 2 vs 5 days; p < 0.001) and had a higher death rate (80.6% vs 30.3%; p < 0.001). The COVID-19 cohort replaced 'typical' caseload; overall numbers of referrals were not increased.Conclusions: Hospitalised COVID-19 positive patients referred for Palliative Care may have a short prognosis, differ from 'typical' caseload, and predominantly suffer from dyspnoea and agitation. Such symptoms can be effectively controlled with standard doses of opioids and benzodiazepines.