Intravenous Fentanyl for Dyspnea at the End of Life

Abstract

This exploratory study shows that IV Fentanyl can alleviate dyspnea in some patients but is an example of the difficulties conducting dyspnea research. Future studies would benefit from novel developments in the areas of measuring dyspnea in dying patients and statistical analysis of small sample sizes.

Respiratory adverse effects of opioids for breathlessness: a systematic review and meta-analysis

“…These studies also showed that opioids caused no significant change in respiratory rate. Finally, the effect on respiratory rate was assessed in three POSs [75,76,80], two ROSs [73,77] and four case reports describing 10 cases [74,78,79,81]. In these studies, the opioids were administered systemically (n=4), nebulised (n=4) or via an unknown route (n=1).…”

Safety and Effectiveness of Palliative Drug Treatment in the Last Days of Life—A Systematic Literature Review

“…Eight studies were performed in Europe, 32e39 two in North America, 40,41 one in Asia, 42 and one in South America. 43 Seven studies were randomized controlled trials (RCTs), 32e36,40,43 four were prospective cohort studies, 37,38,41,42 and one a retrospective cohort study. 39 Eight studies were set in palliative care units or hospices, 34e41 with one of these also including home care patients.…”

“…41 The remaining four studies were set at nonspecialist palliative care hospital wards. 32,33,42,43 All studies were either exclusively or predominantly conducted in patients with a main diagnosis of cancer. The time before death studied was, in all studies except one where it was not reported, 40 either expressed in terms of time from study entry to death or as a life expectancy estimate ( Table 1).…”

“…The studies included a range of different palliative drug treatments. Five studies investigated anticholinergics, 32,35e37,40 five studies opioids, 33,34,39,42,43 three studies benzodiazepines, 33,38,43 and one study investigated an antipsychotic 41 ; seven of the studies evaluated more than one drug. 33e37, 39,43 Five studies looked at death rattle, 32,35e37,40 five studies at dyspnea, 33,38,41e43 and two studies looked at pain.…”

“…34,39 Three of the studies on dyspnea also investigated restlessness, 41 delirium, 38 or anxiety. 43 Overall, seven included studies reported on adverse effects, 33e36, 40,42,43 and three studies reported comparatively on survival. 33,36,38 Data on all primary outcomes (symptom control, adverse effects, and survival) were identified.…”