Hospital Municipal Dr. Moysés Deutsch (L.K.R.D.A, D.C.D.L.S., B.A.C., G.V., C.M.B.F., V.L.A., F.M.D.T.P., L.H.D.C.) Sao Paulo, Brazil; Laboratório de Investigação Médica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina (L.K.R.D.A., T.J.A.S., M.J.A.), Universidade de São Paulo, Sao Paulo, Brazil.
Laboratório de Investigação Médica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina (L.K.R.D.A., T.J.A.S., M.J.A.), Universidade de São Paulo, Sao Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein (T.J.A.S., V.L.A., L.H.D.C.), Sao Paulo, Brazil.
J Pain Symptom Manage. 2022 May;63(5):680-688. doi: 10.1016/j.jpainsymman.2022.01.004. Epub 2022 Jan 10.
As COVID-19 overwhelms health systems worldwide, palliative care strategies may ensure rational use of resources while safeguarding patient comfort and dignity.
To describe palliative care practices in hospitalized middle-aged and older adults in two of the largest COVID-19 treatment centers in Sao Paulo, Brazil.
Retrospective cohort. Eligible patients were those aged 50 years or older hospitalized between March and May 2020 with a laboratory confirmation of SARS-CoV-2 infection. Palliative care implementation was defined as present if medical notes indicated a decision to limit escalation of life support measures, or when opioids or sedatives were prescribed for palliative management of symptoms.
We included 1162 participants (57% male, median 65 years). Overall, 21% were frail and 54% were treated in intensive care units, but only 17% received palliative care. Stepwise logistic regression demonstrated that age ≥80 years, dementia, history of stroke or cancer, frailty, having a PaO/FiO<200 or a C-reactive protein ≥150mg/dL at admission predicted palliative care implementation. Patients placed under palliative care stayed longer (13 vs.11 days) and were more likely to die in hospital (86 vs.27%). They also spent more days in ICU and received vasoactive drugs, hemodialysis, and invasive ventilation more frequently.
One in five middle-aged and older adults hospitalized with COVID-19 received palliative care in our cohort. Patients who were very old, multimorbid, frail, and had severe COVID-19 were more likely to receive palliative care. However, it was often delayed until advanced and invasive life support measures had already been implemented.
随着 COVID-19 在全球范围内使卫生系统不堪重负，姑息治疗策略可以确保资源的合理利用，同时保障患者的舒适和尊严。
描述巴西圣保罗州两个最大的 COVID-19 治疗中心住院的中年和老年患者的姑息治疗实践。
回顾性队列研究。符合条件的患者为 2020 年 3 月至 5 月期间因 SARS-CoV-2 感染住院且实验室确诊的年龄 50 岁或以上的患者。如果医疗记录表明决定限制生命支持措施的升级，或者开具阿片类药物或镇静剂用于姑息治疗症状，则定义为实施了姑息治疗。
共纳入 1162 名参与者（57%为男性，中位年龄 65 岁）。总体而言，21%的患者身体虚弱，54%的患者在重症监护病房接受治疗，但只有 17%的患者接受了姑息治疗。逐步逻辑回归表明，年龄≥80 岁、痴呆、中风或癌症史、虚弱、入院时 PaO/FiO<200 或 C-反应蛋白≥150mg/dL 预测姑息治疗的实施。接受姑息治疗的患者住院时间更长（13 天 vs.11 天），更有可能在医院死亡（86 比 27%）。他们在 ICU 停留的时间也更长，更频繁地接受血管活性药物、血液透析和有创通气。
在我们的队列中，五分之一因 COVID-19 住院的中年和老年患者接受了姑息治疗。非常年老、多病、身体虚弱和患有严重 COVID-19 的患者更有可能接受姑息治疗。然而，姑息治疗通常会延迟到已经实施了先进和有创的生命支持措施之后。
