Palliative care in a COVID-19 Internal Medicine ward: A preliminary report

Abstract

Background: in the current pandemic emergency, increased attention has given to treating symptoms that cause suffering in patients with COVID-19. This study aims to describe the role of palliative care in the management of these patients. Methods: palliative consultation was requested by the staff as per protocol. In brief, the criteria for referring patients to a palliative care physician or to undergo palliative care were left to the discretion of the physician in charge. We recorded data regarding age, gender, length of stay, type of discharge (dead or alive, and transfer to long-term or hospice facilities). Results: Between March 18 to May 8, 2020, 412 patients with COVID-19 were admitted to the Internal Medicine wards of Magenta Hospital, Italy. The palliative care physician was directly involved in 105 cases (25.5%) and performed 236 consultations. Of the 105 patients who received palliative care counselling, 66 (63%) died. The average number of days in care was 2.26 days. The principal reason for counseling was controlling symptoms (54%) and 12% deal with the end of life management. The prevalent symptom, among those which led to the counseling, was restlessness/agitation (41%), followed by emotional issues (26%) such as anxiety, fear, and demoralization. In only 20% of cases, dyspnoea was the reason for symptomatic treatment. Conclusions: A large number of hospitalized Covid-19 patients are at high risk of clinical deterioration and death. This leads to the opportunity to integrate a palliative physician into the staff, who treat these patients. There is an urgent need for protocol standardization and formal trials to verify the effectiveness of this approach.

Palliative Sedation in COVID-19 End-of-Life Care. Retrospective Cohort Study

“…The main medications used were morphine and midazolam, in line with previous studies [ 4 , 5 , 6 , 8 , 12 , 13 ]. Other opioids like alfentanil, fentanyl, buprenorphine, hydromorphone, and oxycodone, associated with a finer approach to alleviating refractory symptoms prior to death, were not used.…”

“…The most commonly reported symptoms in the final days of life were dyspnea at rest, pain, and delirium/agitation, as reported elsewhere [ 4 , 5 , 6 , 8 , 12 , 13 ]. Cough is often a presenting symptom of COVID-19 but was not an ongoing issue in our cohort, unlike others [ 12 ].…”

“…The use of glycopyrrolate, for controlling respiratory secretions, was similar to other studies [ 6 , 8 ]. However, our patients received hyoscine for noisy respiratory secretion, a drug used little in the UK, Italy, and Australia [ 4 , 5 , 6 , 8 , 12 , 13 ].…”

“…COVID-19 has a high mortality rate in patients requiring hospitalization, especially in older patients [ 1 , 2 , 3 ], prompting reflection on the need for palliative care in this population [ 3 ]. To date, studies have analyzed the support and involvement of the palliative medicine unit in end-of-life care in COVID-19 [ 4 , 5 ], the experience of palliative departments and hospital palliative care with these patients [ 6 , 7 , 8 ], the management of COVID-19 end-of-life care by clinicians who are not specialists in palliative care [ 9 ], and the changes that COVID-19 has brought about in the care of oncological and non-oncological palliative patients [ 10 , 11 , 12 ].…”

Hospital-Based Palliative and End-of-Life Care in the COVID-19 Pandemic: A Scoping Review

“…13,19,21 By contrast, an Italian study reported that 41% of patients' predominant symptom was restlessness/agitation, 26% was emotional issues but only 20% presented with dyspnoea as the most prevalent symptom. 23 Comparisons were made between referral patterns for those admitted with COVID-19 and those referred to specialist palliative eservices pre-COVID-19. There were some notable observations.…”