Palliative Care Team, Department of Psychosomatic Medicine and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany.
Palliat Support Care. 2020 Aug;18(4):382-384. doi: 10.1017/S1478951520000450.
The COVID-19 pandemic is a care crisis of unknown duration which has seemingly not yet reached its peak in many countries. A significant number of elderly and frail people and those with underlying serious illness will continue to develop severe forms of the COVID-19 infection. Most of them are not eligible for intensive care treatment but can still expect palliative care - in many cases provided by a Hospital Palliative Care Team (HPCT). Several teams have already gained experience in caring for these patients and their families, others are preparing for it.
We report on a COVID-19 patient with pre-existing acute myeloid leukemia who was looked after by a HPCT until death. We discuss the challenges and difficulties while caring for COVID-19-positive palliative patients in a non-ICU setting.
Hospitalization of the patient in an isolation ward caused an enormous burden for the dying patient and his family. Symptom control was particularly difficult because of rapid deteriorating dyspnea and the scarce presence of medical staff in the patient's room.
COVID-19 patients who are not eligible for ICU treatment may have a particularly high need for palliative care. Since beds in specialist palliative care units are limited, the HPCT should be prepared to care for these patients. They may offer support in decision-making, optimize symptom control, and provide psychosocial care for patients and their families. Visiting restrictions aimed to protect the general public must be weighted against the patient's and family's suffering.
COVID-19 大流行是一场未知持续时间的护理危机，在许多国家似乎尚未达到高峰。相当数量的老年体弱人群和患有潜在严重疾病的人群将继续出现严重的 COVID-19 感染。他们中的大多数不符合重症监护治疗的条件，但仍可以期待姑息治疗——在许多情况下，由医院姑息治疗团队（HPCT）提供。一些团队已经在照顾这些患者及其家属方面积累了经验，其他团队正在为此做准备。
我们报告了一例患有先前存在的急性髓系白血病的 COVID-19 患者，该患者由 HPCT 照顾直至死亡。我们讨论了在非 ICU 环境中照顾 COVID-19 阳性姑息治疗患者时面临的挑战和困难。
将患者安置在隔离病房住院给临终患者及其家属带来了巨大的负担。由于呼吸困难迅速恶化和病房内医务人员稀少，症状控制特别困难。
不符合 ICU 治疗条件的 COVID-19 患者可能特别需要姑息治疗。由于专门的姑息治疗单位的床位有限，HPCT 应准备好照顾这些患者。他们可以在决策制定、优化症状控制以及为患者及其家属提供心理社会关怀方面提供支持。旨在保护公众的探视限制必须权衡患者和家属的痛苦。
