Keeley Paul, Buchanan Deans, Carolan Clare, Pivodic Lara, Tavabie Simon, Noble Simon
Palliative Care Team, Glasgow Royal Infirmary, Glasgow, UK
MVLS, University of Glasgow, Glasgow, UK.
BMJ Support Palliat Care. 2020 Dec;10(4):381-384. doi: 10.1136/bmjspcare-2020-002368. Epub 2020 May 28.
The spread of pandemic COVID-19 has created unprecedented need for information. The pandemic is the cause of significant mortality and with this the need for rapidly disseminated information for palliative care professionals regarding the prevalence of symptoms, their intensity, their resistance or susceptibility to symptom control and the mode of death for patients.
We undertook a systematic review of published evidence for symptoms in patients with COVID-19 (with a specific emphasis on symptoms at end of life) and on modes of death. Inclusion: prospective or retrospective studies detailing symptom presence and/or cause or mode of death from COVID-19.
12 papers met the inclusion criteria and gave details of symptom burden: four of these specifically in the dying and two detailed the cause or mode of death. Cough, breathlessness, fatigue and myalgia are significant symptoms in people hospitalised with COVID-19. Dyspnoea is the most significant symptom in the dying. The mode of death was described in two papers and is predominantly through respiratory or heart failure.
There remains a dearth of information regarding symptom burden and mode of death to inform decisions regarding end-of-life care in patients dying with COVID-19. Rapid data gathering on the mode of death and the profile of symptoms in the dying and their prevalence and severity in areas where COVID-19 is prevalent will provide important intelligence for clinicians. This should be done urgently, within ethical norms and the practicalities of a public health, clinical and logistical emergency.
新冠大流行的传播引发了对信息前所未有的需求。这场大流行导致了大量死亡，因此需要迅速向姑息治疗专业人员传播有关症状的发生率、严重程度、对症状控制的抵抗或易感性以及患者死亡方式的信息。
我们对已发表的关于新冠患者症状（特别强调临终时的症状）和死亡方式的证据进行了系统综述。纳入标准：详细描述新冠患者症状存在情况和/或死因或死亡方式的前瞻性或回顾性研究。
12篇论文符合纳入标准，并给出了症状负担的详细信息：其中4篇专门针对临终患者，2篇详细说明了死因或死亡方式。咳嗽、呼吸困难、疲劳和肌痛是新冠住院患者的显著症状。呼吸困难是临终患者最显著的症状。两篇论文描述了死亡方式，主要是呼吸衰竭或心力衰竭。
关于症状负担和死亡方式的信息仍然匮乏，无法为新冠临终患者的临终关怀决策提供依据。在新冠流行地区迅速收集关于死亡方式、临终患者症状特征及其发生率和严重程度的数据，将为临床医生提供重要信息。这应在伦理规范以及公共卫生、临床和后勤紧急情况的实际情况下紧急完成。
