Effect of hydromorphone on ventilation in palliative care patients with dyspnea.
OBJECTIVE
This study assessed the effect of hydromorphone treatment on ventilation and the intensity of dyspnea in palliative care patients. The assessments measured changes in peripheral oxygen saturation (SaO(2)), transcutaneous arterial pressure of carbon dioxide (tcpaCO(2)), respiratory rate (f), and pulse frequency (PF) during the titration phase with hydromorphone for symptomatic therapy of dyspnea. The aims of the study were to verify the efficacy of hydromorphone for the management of dyspnea and assess its effect on ventilation.


METHODS
Fourteen patients admitted to our palliative care unit were included in this prospective, nonrandomized trial. At admission, all patients suffered from dyspnea. TcpaCO(2), SaO(2), and PF were measured transcutaneously by means of a SenTec Digital Monitor (SenTec AG, Switzerland).


RESULTS
As early as 30 min after the first hydromorphone application, mean respiratory rate decreased from 38.8 +/- 4.9 breaths/min (range 30.0-45.0 breaths/min) to 34.6 +/- 4.2 breaths/min (29.0-41.0 breaths/min); after 120 min to 29.0 +/- 3.1 breaths/min (range 24.0-33.0 breaths/min) (p = 0.001). The other monitored respiratory parameter, however, showed no significant changes. A significant improvement was shown in the intensity of dyspnea [numeric rating scale 0-10: 5.2 +/- 1.5 (4-8)/6.4 +/- 2.1 (4-10) vs 1.1 +/- 0.9 (0-3)/2.3 +/- 1.3 (1-5); p = 0.001].


CONCLUSIONS
Neither was there a significant decrease in SaO(2) nor a significant increase in tcpaCO(2) after the initial hydromorphone application, i.e., there was no hydromorphone-induced respiratory depression. The first hydromorphone application, however, resulted in a significant decrease in the intensity of dyspnea and respiratory rate.
Clemens
Katri Elina
KE
Department of Anaesthesiology, Intensive Care Medicine, Palliative Medicine and Pain Therapy, Malteser Hospital Bonn/Rhein-Sieg, Von-Hompesch-Strasse 1, Bonn, Germany. katri-elena.clemens@malteser.de
Klaschik
Eberhard
E
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000494:pharmacology* / Q000627:therapeutic use; D001785:Blood Gas Monitoring, Transcutaneous; D002245:Carbon Dioxide / Q000378:metabolism; D004417:Dyspnea / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D004091:Hydromorphone / Q000494:pharmacology* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010100:Oxygen / Q000378:metabolism; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D011674:Pulse; D012129:Respiratory Function Tests; D015656:Respiratory Mechanics / Q000187:drug effects; D012720:Severity of Illness Index
D000701:Analgesics, Opioid; D002245:Carbon Dioxide; D004091:Hydromorphone; D010100:Oxygen