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Conservative Management of COVID-19 Patients—Emergency Palliative Care in Action

CONTEXT: The COVID-19 pandemic is spreading across the world. Many patients will not be suitable for mechanical ventilation owing to the underlying health conditions, and they will require a conservative approach including palliative care management for their important symptom burden. OBJECTIVES: To...

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Autores principales: Fusi-Schmidhauser, Tanja, Preston, Nancy J., Keller, Nikola, Gamondi, Claudia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144848/
https://www.ncbi.nlm.nih.gov/pubmed/32276101
http://dx.doi.org/10.1016/j.jpainsymman.2020.03.030
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author Fusi-Schmidhauser, Tanja
Preston, Nancy J.
Keller, Nikola
Gamondi, Claudia
author_facet Fusi-Schmidhauser, Tanja
Preston, Nancy J.
Keller, Nikola
Gamondi, Claudia
author_sort Fusi-Schmidhauser, Tanja
collection PubMed
description CONTEXT: The COVID-19 pandemic is spreading across the world. Many patients will not be suitable for mechanical ventilation owing to the underlying health conditions, and they will require a conservative approach including palliative care management for their important symptom burden. OBJECTIVES: To develop a management plan for patients who are not suitable for mechanical ventilation that is tailored to the stage their COVID-19 disease. METHODS: Patients were identified as being stable, unstable, or at the end of life using the early warning parameters for COVID-19. Furthermore, a COVID-19–specific assessment tool was developed locally, focusing on key symptoms observed in this population which assess dyspnoea, distress, and discomfort. This tool helped to guide the palliative care management as per patients' disease stage. RESULTS: A management plan for all patients' (stable, unstable, end of life) was created and implemented in acute hospitals. Medication guidelines were based on the limitations in resources and availability of drugs. Staff members who were unfamiliar with palliative care required simple, clear instructions to follow including medications for key symptoms such as dyspnoea, distress, fever, and discomfort. Nursing interventions and family involvement were adapted as per patients' disease stage and infection control requirements. CONCLUSION: Palliative care during the COVID-19 pandemic needs to adapt to an emergency style of palliative care as patients can deteriorate rapidly and require quick decisions and clear treatment plans. These need to be easily followed up by generalist staff members caring for these patients. Furthermore, palliative care should be at the forefront to help make the best decisions, give care to families, and offer spiritual support.
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spelling pubmed-71448482020-04-09 Conservative Management of COVID-19 Patients—Emergency Palliative Care in Action Fusi-Schmidhauser, Tanja Preston, Nancy J. Keller, Nikola Gamondi, Claudia J Pain Symptom Manage Article CONTEXT: The COVID-19 pandemic is spreading across the world. Many patients will not be suitable for mechanical ventilation owing to the underlying health conditions, and they will require a conservative approach including palliative care management for their important symptom burden. OBJECTIVES: To develop a management plan for patients who are not suitable for mechanical ventilation that is tailored to the stage their COVID-19 disease. METHODS: Patients were identified as being stable, unstable, or at the end of life using the early warning parameters for COVID-19. Furthermore, a COVID-19–specific assessment tool was developed locally, focusing on key symptoms observed in this population which assess dyspnoea, distress, and discomfort. This tool helped to guide the palliative care management as per patients' disease stage. RESULTS: A management plan for all patients' (stable, unstable, end of life) was created and implemented in acute hospitals. Medication guidelines were based on the limitations in resources and availability of drugs. Staff members who were unfamiliar with palliative care required simple, clear instructions to follow including medications for key symptoms such as dyspnoea, distress, fever, and discomfort. Nursing interventions and family involvement were adapted as per patients' disease stage and infection control requirements. CONCLUSION: Palliative care during the COVID-19 pandemic needs to adapt to an emergency style of palliative care as patients can deteriorate rapidly and require quick decisions and clear treatment plans. These need to be easily followed up by generalist staff members caring for these patients. Furthermore, palliative care should be at the forefront to help make the best decisions, give care to families, and offer spiritual support. American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. 2020-07 2020-04-08 /pmc/articles/PMC7144848/ /pubmed/32276101 http://dx.doi.org/10.1016/j.jpainsymman.2020.03.030 Text en © 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Article
Fusi-Schmidhauser, Tanja
Preston, Nancy J.
Keller, Nikola
Gamondi, Claudia
Conservative Management of COVID-19 Patients—Emergency Palliative Care in Action
title Conservative Management of COVID-19 Patients—Emergency Palliative Care in Action
title_full Conservative Management of COVID-19 Patients—Emergency Palliative Care in Action
title_fullStr Conservative Management of COVID-19 Patients—Emergency Palliative Care in Action
title_full_unstemmed Conservative Management of COVID-19 Patients—Emergency Palliative Care in Action
title_short Conservative Management of COVID-19 Patients—Emergency Palliative Care in Action
title_sort conservative management of covid-19 patients—emergency palliative care in action
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144848/
https://www.ncbi.nlm.nih.gov/pubmed/32276101
http://dx.doi.org/10.1016/j.jpainsymman.2020.03.030
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