Internal Medicine Department, Alicante General University Hospital-Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain.
Clinical Medicine Department, Miguel Hernández University, 03550 Elche, Spain.
Medicina (Kaunas). 2021 Aug 26;57(9):873. doi: 10.3390/medicina57090873.
Descriptions of end-of-life in COVID-19 are limited to small cross-sectional studies. We aimed to assess end-of-life care in inpatients with COVID-19 at Alicante General University Hospital (ALC) and compare differences according to palliative and non-palliative sedation. : This was a retrospective cohort study in inpatients included in the ALC COVID-19 Registry (PCR-RT or antigen-confirmed cases) who died during conventional admission from 1 March to 15 December 2020. We evaluated differences among deceased cases according to administration of palliative sedation. Of 747 patients evaluated, 101 died (13.5%). Sixty-eight (67.3%) died in acute medical wards, and 30 (44.1%) received palliative sedation. The median age of patients with palliative sedation was 85 years; 44% were women, and 30% of cases were nosocomial. Patients with nosocomial acquisition received more palliative sedation than those infected in the community (81.8% [9/11] vs 36.8% [21/57], = 0.006), and patients admitted with an altered mental state received it less (20% [6/23] vs. 53.3% [24/45], = 0.032). The median time from admission to starting palliative sedation was 8.5 days (interquartile range [IQR] 3.0-14.5). The main symptoms leading to palliative sedation were dyspnea at rest (90%), pain (60%), and delirium/agitation (36.7%). The median time from palliative sedation to death was 21.8 h (IQR 10.4-41.1). Morphine was used in all palliative sedation perfusions: the main regimen was morphine + hyoscine butyl bromide + midazolam (43.3%). : End-of-life palliative sedation in patients with COVID-19 was initiated quite late. Clinicians should anticipate the need for palliative sedation in these patients and recognize the breathlessness, pain, and agitation/delirium that foreshadow death.
对 COVID-19 末期的描述仅限于小型的横断面研究。我们旨在评估阿利坎特综合大学医院（ALC）住院 COVID-19 患者的临终关怀，并根据姑息和非姑息镇静进行比较。：这是一项回顾性队列研究，纳入了 2020 年 3 月 1 日至 12 月 15 日期间在 ALC COVID-19 登记处（PCR-RT 或抗原确诊病例）常规住院期间死亡的住院患者。我们根据姑息镇静的应用评估了死亡病例之间的差异。在评估的 747 名患者中，有 101 人死亡（13.5%）。68 例（67.3%）死亡于急性内科病房，30 例（44.1%）接受了姑息镇静。接受姑息镇静的患者中位年龄为 85 岁；44%为女性，30%的病例为院内获得性感染。院内获得性感染患者比社区感染患者接受更多的姑息镇静治疗（81.8%[9/11] vs. 36.8%[21/57]， = 0.006），而入院时意识状态改变的患者接受的姑息镇静治疗较少（20%[6/23] vs. 53.3%[24/45]， = 0.032）。从入院到开始姑息镇静的中位时间为 8.5 天（四分位距 [IQR] 3.0-14.5）。导致姑息镇静的主要症状是静息时呼吸困难（90%）、疼痛（60%）和谵妄/激越（36.7%）。从姑息镇静开始到死亡的中位时间为 21.8 小时（IQR 10.4-41.1）。所有姑息镇静输注均使用吗啡：主要方案为吗啡+氢溴酸东莨菪碱+咪达唑仑（43.3%）。：COVID-19 患者的临终姑息镇静治疗开始得相当晚。临床医生应预见到这些患者需要姑息镇静，并认识到预示死亡的呼吸困难、疼痛和激越/谵妄。
