Dartmouth-Hitchcock Medical Center, Pulmonary and Critical Care Medicine, Lebanon, NH 03756-0001, USA.
Chest. 2010 Mar;137(3):674-91. doi: 10.1378/chest.09-1543.
This consensus statement was developed based on the understanding that patients with advanced lung or heart disease are not being treated consistently and effectively for relief of dyspnea.
A panel of experts was convened. After a literature review, the panel developed 23 statements covering five domains that were considered relevant to the topic condition. Endorsement of these statements was assessed by levels of agreement or disagreement on a five-point Likert scale using two rounds of the Delphi method.
The panel defined the topic condition as "dyspnea that persists at rest or with minimal activity and is distressful despite optimal therapy of advanced lung or heart disease." The five domains were: measurement of patient-reported dyspnea, oxygen therapy, other therapies, opioid medications, and ethical issues. In the second round of the Delphi method, 34 of 56 individuals (61%) responded, and agreement of at least 70% was achieved for 20 of the 23 statements.
For patients with advanced lung or heart disease, we suggest that: health-care professionals are ethically obligated to treat dyspnea, patients should be asked to rate the intensity of their breathlessness as part of a comprehensive care plan, opioids should be dosed and titrated for relief of dyspnea in the individual patient, both the patient and clinician should reassess whether specific treatments are serving the goal of palliating dyspnea without causing adverse effects, and it is important for clinicians to communicate about palliative and end-of-life care with their patients.
本共识声明是基于这样一种理解而制定的，即患有晚期肺病或心脏病的患者并未得到一致和有效的治疗以缓解呼吸困难。
召集了一组专家。在进行文献回顾后，专家组就涵盖与主题条件相关的五个领域的 23 个陈述进行了制定。通过两轮德尔菲法，使用五点李克特量表对这些陈述的赞同程度进行评估，以表示同意或不同意。
专家组将主题条件定义为“尽管对晚期肺病或心脏病进行了最佳治疗，但仍持续存在于休息或最小活动时的呼吸困难，并伴有痛苦”。五个领域为：患者报告的呼吸困难的测量、氧疗、其他疗法、阿片类药物和伦理问题。在第二轮德尔菲法中，56 人中的 34 人（61%）做出了回应，对于 23 个陈述中的 20 个达成了至少 70%的一致。
对于患有晚期肺病或心脏病的患者，我们建议：医疗保健专业人员在道德上有义务治疗呼吸困难，应要求患者对其呼吸困难的强度进行评分，作为全面护理计划的一部分，应根据个体患者的情况对阿片类药物进行剂量调整以缓解呼吸困难，患者和临床医生都应重新评估特定治疗方法是否在缓解呼吸困难而不引起不良反应的情况下达到姑息治疗的目标，临床医生与患者就姑息治疗和临终关怀进行沟通非常重要。
