A Case Report of Phenobarbital for Proportionate Sedation to Control Refractory Symptoms at the End of Life in an Opioid Tolerant Patient

2021 ◽  
pp. 1-8
Author(s):  
Jessica F. Jones ◽  
Jeremy M. Hirst ◽  
Kyle P. Edmonds ◽  
Rabia S. Atayee
Keyword(s):  
Case Report ◽  
End Of Life ◽  
Refractory Symptoms

scholarly journals Use With Precaution: A Case Report of Hypocalcemia Caused by Denosumab at the End of Life

2018 ◽  
Vol 56 (6) ◽  
pp. e118 ◽  
Author(s):  
Kozue Suzuki ◽  
Yukari Azuma ◽  
Yo Tei ◽  
Keiko Tanaka
Keyword(s):  
Case Report ◽  
End Of Life

Palliative Sedation in End-of-Life Care and Survival: A Systematic Review

2012 ◽  
Vol 30 (12) ◽  
pp. 1378-1383 ◽  
Author(s):  
Marco Maltoni ◽  
Emanuela Scarpi ◽  
Marta Rosati ◽  
Stefania Derni ◽  
Laura Fabbri ◽  
...  
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Randomized Clinical Trials ◽  
Palliative Sedation ◽  
Life Care ◽  
Review Of Literature ◽  
Refractory Symptoms ◽  
Manual Search

Purpose Palliative sedation is a clinical procedure aimed at relieving refractory symptoms in patients with advanced cancer. It has been suggested that sedative drugs may shorten life, but few studies exist comparing the survival of sedated and nonsedated patients. We present a systematic review of literature on the clinical practice of palliative sedation to assess the effect, if any, on survival. Methods A systematic review of literature published between January 1980 and December 2010 was performed using MEDLINE and EMBASE databases. Search terms included palliative sedation, terminal sedation, refractory symptoms, cancer, neoplasm, palliative care, terminally ill, end-of-life care, and survival. A manual search of the bibliographies of electronically identified articles was also performed. Results Eleven published articles were identified describing 1,807 consecutive patients in 10 retrospective or prospective nonrandomized studies, 621 (34.4%) of whom were sedated. One case-control study was excluded from prevalence analysis. The most frequent reason for sedation was delirium in the terminal stages of illness (median, 57.1%; range, 13.8% to 91.3%). Benzodiazepines were the most common drug category prescribed. Comparing survival of sedated and nonsedated patients, the sedation approach was not shown to be associated with worse survival. Conclusion Even if there is no direct evidence from randomized clinical trials, palliative sedation, when appropriately indicated and correctly used to relieve unbearable suffering, does not seem to have any detrimental effect on survival of patients with terminal cancer. In this setting, palliative sedation is a medical intervention that must be considered as part of a continuum of palliative care.

Beyond striae cutis: A case report on how physical skin complaints unveiled end-of-life total experience

2020 ◽  
pp. 1-3
Author(s):  
Miguel Julião ◽  
Paula Calçada ◽  
Vasco Coelho Macias ◽  
Pedro Mendes-Bastos
Keyword(s):  
Case Report ◽  
End Of Life ◽  
Multidisciplinary Team ◽  
Life Experience ◽  
Terminally Ill ◽  
Multidisciplinary Teams ◽  
Terminal Cancer ◽  
Physical Pain ◽  
Holistic Approaches ◽  
Physical Distress

Abstract Background End-of-life is a unique and multidimensional experience, and physical complaints can reveal other areas of distress. Method A case report of a woman with terminal cancer with painful and deforming skin striae cared by a multidisciplinary team. Results After initially treating her physical pain, other end-of-life psychosocial, spiritual, and existential aspects could be addressed. Significance of results Physical distress can unveil other essential areas of end-of-life experience when multidisciplinary teams caring for the terminally ill patients use holistic approaches.

scholarly journals Case Report: Implantable cardioverter defibrillator (ICD) deactivation in palliative care - a case involving best interest decisions for someone lacking capacity at the end of life

2021 ◽  
Vol 3 ◽  
pp. 4
Author(s):  
Chevonne Tan ◽  
Sarika Hanchanale ◽  
Emma Sugrue ◽  
Amara Callistus Nwosu
Keyword(s):  
Case Report ◽  
End Of Life ◽  
Care Planning ◽  
Implantable Cardioverter Defibrillators ◽  
Best Interest ◽  
Cardioverter Defibrillator ◽  
Advance Care ◽  
New Challenges ◽  
Cardioverter Defibrillators ◽  
Dying Patient

The use of implantable cardioverter-defibrillators (ICD) has increased due to benefits of preventing death from cardiac arrhythmia. However, the increasing use of ICDs has created new challenges for how to proactively manage deactivation of these devices in people who are dying, especially for those who lack capacity to make decisions about their care. The aim of this case report is to discuss the challenges of planning for deactivation of an ICD for a patient who lacked capacity at the end of life. We describe the challenges of managing ICD deactivation in a dying patient with fluctuating capacity who had previously expressed a wish for the ICD to remain active. Although it is preferable to use advance care planning (ACP), to provide care in-line with patient-identified care preferences, we demonstrate how a best interest process can be used to make decisions about ICD deactivation at the end of life.

scholarly journals ECCO2R as a bridge to a decision in type II respiratory failure

2019 ◽  
Vol 26 (1) ◽  
pp. 101-106
Author(s):  
Lina Grauslytė ◽  
Gonzalo De La Cerda ◽  
Tomas Jovaiša
Keyword(s):  
Decision Making ◽  
Case Report ◽  
Respiratory Failure ◽  
End Of Life ◽  
Lung Transplant ◽  
Life Support ◽  
Support Systems ◽  
Extracorporeal Life Support ◽  
Life Support Systems ◽  
End Of Life Decisions

Introduction. End-of-life decisions are often time consuming and difficult for everyone involved. In some of these cases extracorporeal life support systems could potentially be used not only as a bridge to treatment but as a tool to buy time to allow patient’s participation in decision making and to avoid further futile invasive procedures. Case report. A previously healthy 53-year-old female patient presented with respiratory failure of unknown cause. In the course of treatment her condition was deemed irreversible and the only option for any chance of long-term survival was a lung transplant. During this whole time the patient’s condition was managed with extracorporeal carbon dioxide removal system (ECCO2R). She remained compos mentis and expressed the wish to stop all the treatment as the option of lung transplant was not acceptable to her. Treatment was withdrawn and she passed away. Discussion. In cases of end-of-life decisions, time can play an essential role. Even though extracorporeal life support systems have been conceptualised to be a bridge to treatment, they could be beneficial in a situation when time is needed to make a decision. ECCO2R has been used as a treatment method in different settings, however, in this case it served as a tool to maintain the patient alive and conscious for a sufficient time for her to participate in decision making. Conclusions. Our case report demonstrated that ECCO2R could serve as a bridge to decision in situations when time is limited and the decisions that need to be made are difficult.

Facilitating End-of-Life Interaction Between Patients With Severe Communication Impairment and Their Families

2021 ◽  
pp. 1-5
Author(s):  
Adithya Chandregowda ◽  
Julie A. G. Stierwalt ◽  
Heather M. Clark
Keyword(s):  
Case Report ◽  
Clinical Practice ◽  
End Of Life ◽  
Chart Review ◽  
Clinical Implications ◽  
Pertinent Literature ◽  
Communication Impairment ◽  
Medical Chart Review ◽  
Patient Interaction ◽  
Alertness Level

Purpose The purpose of this report is to promote conversation among medical speech-language pathologists (SLPs) about their role in facilitating family–patient interaction involving patients who acutely encounter the end-of-life (EOL) phase and have severe communication impairment. Case Report We provide self-reflections from our own clinical practice, pertinent literature review, and medical chart review of a relevant patient to serve as a catalyst for such discussion. Reflections We share a preliminary handout containing strategies that SLPs could provide family members of patients who have encountered an EOL phase and have severe communication impairment (e.g., global aphasia) and reduced alertness level. Clinical Implications SLPs can play an important role in facilitating EOL patient–family interaction and alleviate suffering even when patients have severe communication impairment.

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