Hospital Selayang, Palliative Care Unit, Department of Medicine, Malaysia.
Med J Malaysia. 2022 Jul;77(4):454-461.
Coronavirus disease 2019 (COVID-19) variants pose unique challenges with inevitable premature death when cases of severe disease exponentially rise in a healthcare system. It is imperative that palliative care is provided with a proactive approach to symptom recognition, assessment, management and treatment escalation to ensure comfort throughout the course of this illness.
To evaluate the characteristics, symptom burden, palliative care management and outcomes of COVID-19 patients referred to a palliative care unit (PCU) in a single tertiary hospital. Clinical outcomes specifically observed the management of agitation in these patients based on their Richmond Agitation and Sedation Scale (RASS) scores.
A retrospective observational study was conducted in a tertiary hospital by reviewing electronic medical records and extracting data from 1st June 2021to 31st July 2021 of all COVID-19 patients referred to the PCU.
A cohort of 154 (75 males, 79 females) COVID-19 patients was referred to the PCU with a mean age of 67 (20- 95) years. The median number of days of COVID-19 illness before referral was 7(4-11), with 79.3% of patients being in categories 4 and 5. The median duration of the PCU involvement was 4(1-24) days; 74% of families were engaged in virtual platform communication. The most prevalent symptoms were dyspnoea (73.4%) and agitation (41.6%). Common medications used were opioids, antipsychotics and benzodiazepines. Among agitated patients, none had RASS scores above +2 in the last encounter. Palliative care doctors in the team reported complete effectiveness in patient's symptom control in 74% of patients.
A hallmark of severe COVID-19 is rapid deterioration, which calls for proactive assessment and urgent palliation. Breathlessness and agitation are priority symptoms to address. Among agitated patients, benzodiazepines and antipsychotics are highly effective in addressing agitation and reducing RASS scores. Communication with families using virtual platforms is effective in providing a supportive presence and closure when face-to-face communication is not possible.
2019 年冠状病毒病（COVID-19）变异株带来了独特的挑战，当医疗系统中严重疾病病例呈指数级增长时，必然会导致过早死亡。当这种疾病发生时，积极主动地识别、评估、管理症状并升级治疗以确保患者舒适是至关重要的，这就需要姑息治疗。
评估在一家三级医院的姑息治疗病房（PCU）接受治疗的 COVID-19 患者的特征、症状负担、姑息治疗管理和结局。临床结局特别观察了这些患者根据其 Richmond 激越和镇静量表（RASS）评分进行的激越管理。
通过回顾电子病历，对 2021 年 6 月 1 日至 2021 年 7 月 31 日期间所有转诊至 PCU 的 COVID-19 患者的数据进行回顾性观察性研究。
共纳入了 154 名（75 名男性，79 名女性）COVID-19 患者，平均年龄为 67 岁（20-95 岁）。转诊前 COVID-19 患病的中位数天数为 7 天（4-11 天），79.3%的患者处于 4 类和 5 类。PCU 治疗的中位数持续时间为 4 天（1-24 天）；74%的家庭参与了虚拟平台的沟通。最常见的症状是呼吸困难（73.4%）和激越（41.6%）。常用药物包括阿片类药物、抗精神病药和苯二氮䓬类药物。在激越的患者中，最后一次就诊时没有 RASS 评分超过+2 的患者。姑息治疗医生报告说，74%的患者的症状控制完全有效。
严重 COVID-19 的一个标志是迅速恶化，这需要积极主动地评估和紧急姑息治疗。呼吸困难和激越是需要优先解决的症状。在激越的患者中，苯二氮䓬类药物和抗精神病药在解决激越和降低 RASS 评分方面非常有效。在无法进行面对面沟通时，使用虚拟平台与家属进行沟通是提供支持和结束治疗的有效方法。
