Management of Dyspnea in the Terminally Ill.
Chest. 2018 Apr 18;:
Authors: Pisani L, Hill NS, Pacilli AMG, Polastri M, Nava S
The genesis of dyspnea involves the activation of several mechanisms that are mediated and perceived depending on previous experiences, values, emotions and beliefs. Breathlessness may become unbearable, especially in terminally ill patients, whether afflicted by respiratory, cardiac or cancer-related disorders, due to a final stage of a chronic process, an acute event or both. Compared to pain, palliation of dyspnea has received relatively little attention in clinical practice and the medical literature. This is particularly true when the breathlessness is associated with acute respiratory failure since most of the studies on pharmacological and non-pharmacological treatments of respiratory distress have excluded such patients. Assessments of the quality of dying for patients in an ICU consistently show that few patients are considered by family members to "breathe comfortably" at the end of their life. This Review focuses on the management of dyspnea in patients with advanced terminal illness, summarising clinical trial evidence on pharmacological and non-pharmacologic interventions available for these patients.
PMID: 29679597 [PubMed - as supplied by publisher]