Neither guidelines nor symptom-targeted opioids are harmful when withdrawing life-sustaining measures

Downar, James; Delaney, Jesse W; Hawryluck, Laura; Kenny, Lisa

doi:10.1007/s00134-016-4390-8

Cited by 2 publications

(1 citation statement)

References 4 publications

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“…Studies of severe acute respiratory illness have suggested that many patients with respiratory failure can recover effectively without mechanical assistance, and opioids can be used to treat dyspnea without increasing mortality. 26 A patient unable to receive invasive mechanical ventilation may be able to receive supplemental oxygen through a noninvasive route as resources permit. The implementation of early palliative care interventions can provide a better quality of life, less treatment intensity, and no consistent impact on mortality.…”

Section: Standards Of Carementioning

confidence: 99%

Triage of Scarce Critical Care Resources in COVID-19 An Implementation Guide for Regional Allocation

Maves

Downar

Dichter

et al. 2020

Chest

Self Cite

250

174

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Endorsed by the American Association of Critical-Care Nurses and the Society of Critical Care Medicine Public health emergencies have the potential to place enormous strain on health systems. The current pandemic of the novel 2019 coronavirus disease has required hospitals in numerous countries to expand their surge capacity to meet the needs of patients with critical illness. When even surge capacity is exceeded, however, principles of critical care triage may be needed as a means to allocate scarce resources, such as mechanical ventilators or key medications. The goal of a triage system is to direct limited resources towards patients most likely to benefit from them. Implementing a triage system requires careful coordination between clinicians, health systems, local and regional governments, and the public, with a goal of transparency to maintain trust. We discuss the principles of tertiary triage and methods for implementing such a system, emphasizing that these systems should serve only as a last resort. Even under triage, we must uphold our obligation to care for all patients as best possible under difficult circumstances.

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Section: Standards Of Carementioning

confidence: 99%

Triage of Scarce Critical Care Resources in COVID-19 An Implementation Guide for Regional Allocation

Maves

Downar

Dichter

et al. 2020

Chest

Self Cite

250

174

View full text Add to dashboard Cite

show abstract

Hospice and Palliative Care in Chronic Obstructive Pulmonary Disease

Shin

Park

Lee

2017

Korean J Hosp Palliat Care

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Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation that is usually progressive. It is a major cause of morbidity and mortality worldwide, leading to substantial and increasing economic and social burden. Palliative care for COPD patients aims to reduce symptoms and exacerbations and improve exercise tolerance and quality of life. It is difficult to make a prognosis for COPD patients due to the variable illness trajectory and advanced care of patients. However, severity of breathlessness, assessment of lung function impairment, and frequency of exacerbations can help to identify palliative care needs and determine effective methods to mitigate symptoms, which is discussed in this paper. In these patients, it is recommended to provide individualized palliative care along with curative/restorative care at the onset of COPD symptoms. Before launching a palliative care system in Korea, it is necessary to prepare pulmonary rehabilitation resources, patient-centered communication, timely palliative responsiveness, and a program for effective advanced care planning. A multidisciplinary approach involving collaboration with not only the respiratory and palliative care teams but also primary care offers a new model of care for these patients and should be considered with a priority.

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Neither guidelines nor symptom-targeted opioids are harmful when withdrawing life-sustaining measures

Cited by 2 publications

References 4 publications

Triage of Scarce Critical Care Resources in COVID-19 An Implementation Guide for Regional Allocation

Triage of Scarce Critical Care Resources in COVID-19 An Implementation Guide for Regional Allocation

Hospice and Palliative Care in Chronic Obstructive Pulmonary Disease

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