Biesbrouck Tim, Jennes Dine Ad, Van Den Noortgate Nele, De Roo Maaike L
Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Leuven, Belgium.
Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.
Palliat Med. 2024 Dec;38(10):1088-1104. doi: 10.1177/02692163241286648. Epub 2024 Oct 10.
Evidence based guidelines for treatment of physical symptoms during the last days of life in older people are not available.
We wanted to synthesize the existing evidence on the pharmacological treatment of pain, dyspnea, death rattle, fever, nausea, and vomiting during the last days of life in older people to develop recommendations that can help guide clinical practice.
A systematic review was conducted (PROSPERO #CRD42023406100) and reported in accordance with PRISMA guidelines.
MEDLINE and EMBASE were searched from inception till March 2023, together with national and international guideline databases.
Four predominantly descriptive studies on opioid use were included for the treatment of pain and four for dyspnea, without clear evidence for the choice of one specific opioid, nor a specific opioid dose. For death rattle, five randomized controlled trials and two retrospective studies were included. These provide evidence for the prophylactic treatment of death rattle with hyoscine butylbromide. For fever, nausea, and vomiting, no articles met the inclusion criteria.
Limited evidence exists to guide the pharmacological treatment of pain, dyspnea, death rattle, fever, nausea, and vomiting in the last days of life of older people. Other than the use of opioids for treatment of pain and dyspnea and prophylactic administration of hyoscine butylbromide to decrease the likelihood of developing death rattle, no specific recommendations can be formulated for use in clinical practice. This demonstrates the challenging nature of research in the last days of life of older people, despite its pressing need.
目前尚无基于证据的老年人临终前身体症状治疗指南。
我们希望综合现有关于老年人临终前疼痛、呼吸困难、临终喉鸣、发热、恶心和呕吐药物治疗的证据，以制定有助于指导临床实践的建议。
进行了一项系统综述（PROSPERO #CRD42023406100），并按照PRISMA指南进行报告。
检索了MEDLINE和EMBASE自数据库建立至2023年3月的数据，以及国家和国际指南数据库。
纳入了四项主要关于阿片类药物使用的描述性研究用于疼痛治疗，四项用于呼吸困难治疗，没有明确证据表明应选择一种特定的阿片类药物，也没有特定的阿片类药物剂量。对于临终喉鸣，纳入了五项随机对照试验和两项回顾性研究。这些研究为使用丁溴东莨菪碱预防性治疗临终喉鸣提供了证据。对于发热、恶心和呕吐，没有文章符合纳入标准。
在老年人临终前疼痛、呼吸困难、临终喉鸣、发热、恶心和呕吐的药物治疗方面，可用于指导的证据有限。除了使用阿片类药物治疗疼痛和呼吸困难以及预防性使用丁溴东莨菪碱以降低发生临终喉鸣的可能性外，无法制定用于临床实践的具体建议。这表明尽管迫切需要，但老年人临终前研究具有挑战性。
