This European article focuses on emergency medicine palliative care guidelines for assessment and treatment of COVID-19 patients who are stable, unstable or near the end of life.
3 categories of palliative care patients were created by initial assessment (WHO early warning parameters, saturation levels, respiratory rate, and a local COVID-19 specific assessment tool):
- Stable- Patients may still recover but have a high symptom burden. Morphine and Lorazepam were often utilized to manage symptoms. Virtual family visits were possible, but in-person visits were time-consuming for staff and risked contamination.
- Unstable-Patients are not going to recover. They experience rapid deterioration and O2 saturation < 88% irrespective of oxygen supplementation. Treatment focuses on symptom management, hydration, and comfort care. Family visits may be possible but brief.
- End of Life– Patients have low saturation levels and are dying. Inability to communicate necessitates more frequent symptom assessment, and combinations of benzodiazepines and anti-psychotics were used for sedation. Oxygen supplementation was not helpful, opioids for comfort were preferred. In person visits were preferred as virtual visits were found to be highly distressing to the patient’s family.
For patients whom mechanical ventilation is an unsuitable treatment, palliative care management is needed. The authors have generated clear care guidelines, including specific assessment tools and medication dosing, to aid in palliative treatment by non-specialist medical professionals who may not be as familiar with end-of-life and comfort care.
Fusi-Schmidhauser T, Preston NJ, Keller N, Gamondi C. Conservative Management of COVID-19 Patients—Emergency Palliative Care in Action. J Pain Symptom Manage. 2020;60(1):e27-e30. doi:10.1016/j.jpainsymman.2020.03.030
This review was posted on behalf of Lauren Albert, IU School of Medicine student, and reviewed by Dr. Kathleen Unroe, IU School of Medicine Associate Professor, geriatrician, and IU Center for Aging Research Scientist