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Apr/20:Characteristics, symptom mngmt & outcomes of 101 patients w/COVID-19


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The full title of this UK paper is "Characteristics, symptom management and outcomes of 101 patients with COVID-19 referred for hospital palliative care".

 

https://www.ncbi.nlm.nih.gov/pubmed/32325167

 

Abstract

 

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 in-patients with confirmed COVID-19 referred to hospital palliative care. Patients (64 male, median [iQR] age 82 [72-89] years, Elixhauser Comorbidity Index 6 [2-10], Australian-modified Karnofsky Performance Status 20 [10-20]), were most frequently referred for end of life care or symptom control. Median [iQR] days from hospital admission to referral was 4 [1-12] 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-maximum dose/24h) were opioids (morphine, 10-30mg; fentanyl, 100-200mcg; alfentanil 500-1000 mcg) and midazolam (10-20mg). 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 dataset for palliative care would accelerate finding answers to new questions as the COVID-19 pandemic develops.

 

Journal "Pre-Proof":

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7169932/pdf/main.pdf

 

 

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Another reason to avoid getting Covid19 at all costs, if the virus doesn't kill you, you end up in benzodiazepine withdrawal.
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Yes, for those of us who wouldn't want to take benzos again, the use of midazolam for "palliative care" with COVID-19 patients is rather scary. One would hope that medication options are discussed before being administered, but of course, it would depend on the person's level of consciousness and, perhaps, how likely they are to recover. For people who need to be intubated, I'm guessing benzos or propofol would be used for sedation.

 

In this paper, about 75% of the patients died, but others didn't, so the palliative care served as comfort during their convalescence.

 

Apparently, the studies on COVID-19 are coming out quickly, so there will likely be much more information to come. This is just the start.

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