Out-of-hospital opioid therapy of palliative care patients with "acute dyspnoea": a retrospective multicenter investigation.
BACKGROUND
Prehospital emergency physicians (EP) are often confronted with the acute care of palliative care patients. Dyspnoea is a frequent acute symptom and its causes often differ from the generally known emergency medical causes. Till now, there have been no relevant concepts for emergency care of palliative care patients for their specific symptoms.


METHODS
Over a 24-month period, the authors retrospectively investigated all out-of-hospital emergency medical services for palliative care patients with acute dyspnoea at four emergency physician support points. The evaluation of these services was followed retrospectively on the basis of the therapy carried out by the EP (Group 1: therapy with morphine and oxygen; Group 2: therapy with morphine, bronchodilator effective drugs and oxygen; Group 3: therapy with bronchodilator effective drugs and oxygen; Group 4: therapy with oxygen; Group 5: no medical treatment). Moreover, EPs were interviewed about their actions and their uncertainties in the treatment of palliative care patients.


RESULTS
The diagnosis of acute dyspnoea in palliative care patients occurred 121 times (116 patients were integrated in the present investigation) within the defined period. In total, 116 patients were included (Group 1: 21, Group 2: 29, Group 3: 31, Group 4: 28, and Group 5: 7). Dyspnoea was satisfactorily treated in 41 percent of the patients (Group 1: 67 percent, Group 2: 52 percent, Group 3: 22 percent, Group 4: 18 percent, and Group 5: 71 percent). Most EPs (70 percent) revealed uncertainties in emergency medical therapy for patients at the end of life.


CONCLUSIONS
The current investigation showed a significant relief of acute dyspnoea when using opioids, in contrast with the established out-of-hospital emergency medical therapy for acute dyspnoea. Therefore, opioids should be recommended for emergency medical therapy of dyspnoea in palliative care patients. Clinical studies that recommend the use of effective opioids for the treatment of dyspnoea in palliative care patients are supported by the current retrospective study. Most EPs felt uncertain in the treatment of palliative care patients. Therefore, advanced training in palliative care medicine and end-of-life care should be integrated into emergency medical training.
Wiese
Christoph H R
CH
Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Medical Centre, Goettingen, Germany.
Barrels
Utz E
UE
Graf
Bernhard M
BM
Hanekop
Gerd G
GG
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001993:Bronchodilator Agents / Q000627:therapeutic use; D004417:Dyspnea / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D004632:Emergency Medical Services; D005260:Female; D005858:Germany; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D009369:Neoplasms / Q000150:complications / Q000628:therapy*; D010102:Oxygen Inhalation Therapy; D010166:Palliative Care; D012189:Retrospective Studies; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D001993:Bronchodilator Agents; D009020:Morphine