Use of clinical pictures in the management of nausea and vomiting: a prospective audit

Abstract

This prospective audit aimed to evaluate a guideline for the management of nausea and vomiting in palliative care inpatients. Clinical pictures were used to guide diagnosis and treatment, with potentially reversible causes being addressed where appropriate. Over a 3-month period, 40 patient episodes occurred, all of which were included in the audit. The commonest clinical pictures were gastric stasis/outlet obstruction (35%) and chemical/metabolic (30%). Management according to the guideline was effective. Nausea was abolished in 28 of 34 cases (82%) and vomiting resolved completely in 26 of 31 cases (84%). Symptoms were totally controlled in a mean time of 3.4 days. Nausea and vomiting, although distressing symptoms, can be controlled in the majority of cases. Multi-centre prospective audit, using a standardized tool, may prove useful in allowing larger numbers of patients to be systematically analysed and individual centres to compare outcomes.

Systematic review of the efficacy of antiemetics in the treatment of nausea in patients with far-advanced cancer

“…Experts in the field claim that the cause of nausea and vomiting can be determined clinically in 90% cases [8,9], although they recognize that the cause is usually multifactorial. It is claimed that more than 80% of patients can have their nausea and vomiting controlled when treated in this way [8,10]. The evidence upon which this claim is made warrants review.…”

“…Antiemetic choice is based on identifying the likely mechanism of the symptoms from the clinical picture and applying knowledge of the neuropharmacology of the emetic pathway [6,7]. Experts in the field claim that the cause of nausea and vomiting can be determined clinically in 90% cases [8,9], although they recognize that the cause is usually multifactorial. It is claimed that more than 80% of patients can have their nausea and vomiting controlled when treated in this way [8,10].…”

Palliativmedizin

“…B. Schmerz, Übelkeit, Erbrechen, Agitation, Dyspnoe), der Umgang mit Krisensituationen sowie ethische Fragestellungen beispielsweise bezüglich Therapieindikation bzw. -reduktion sind in unterschiedlichen Bereichen der Anäs-thesiologie in der täglichen Routine gegeben [3,5,11,12,16,17,18,19,22,23,32]. Eine Übertragbarkeit anästhesiologisch-therapeutischer Optionen ist -allerdings mit zusätzlichen palliativmedizinischen Aspekten (beispielsweise Berücksichtigung psychosozialer und spiritueller Faktoren) -in der Palliativmedizin durchaus denkbar.…”

“…Die Anästhesiologie kann mit ihren einzelnen Subspezialisierungen und weitreichenden Erfahrungen in der Kooperation mit anderen Fachdisziplinen und Professionen für eine solche Therapiekoordination hilfreich sein [4,5,9,11,16,17,18,20,37]. Aufgrund der bereits bestehenden Vielseitigkeit des Faches und der breiten fachlichen Herausforderungen in der täglichen Klinikroutine sollte die Palliativmedizin für Anästhesisten als koordinierende Instanz keine unlösbare Aufgabe darstellen.…”

Symptom Control in Palliative Care—Part I: Oncology as a Paradigmatic Example

“…Two prospective audits of current practice have showed response rates of 80%-90% when following this approach. 74,75 An alternative approach of empiric treatment has been recommended by some, and in studies was found to be highly effective. [76][77][78][79] There have been no head to head comparisons of these approaches.…”