Extreme Symptom Burden for Patients With COVID-19 at the End of Life; Extrapolation of Knowledge Gained to Achieve Sustained Comfort and Dignity for all Patients in Their Last Days of Life1.
Dympna Waldron, Christine Eileen Mc Carthy, David Murphy and 4 others
PMID 36912148WHAT IT FOUND
Dying patients with severe agitation became comfortable after multiple drugs were given together, including phenobarbitone, diclofenac, and procyclidine.
No single drug can be credited.
Key findings
01Two patients with COVID-19 at end of life had severe agitation and complex symptoms that did not settle with morphine, midazolam, and other medicines commonly used in palliative care.
02The team clinically attributed the cancer patient's extreme agitation to severe insomnia rather than delirium.
03In the case with abnormal movements, agitation, and fever, symptoms improved after several medicines were given together, including phenobarbitone, diclofenac, and procyclidine, alongside alfentanil, morphine, midazolam, haloperidol, glycopyrronium, and hyoscine butylbromide. No single drug can be credited.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a case report series, not a trial, so it cannot show that any treatment works. Many medicines were given at the same time, and the report does not separate the effect of phenobarbitone, diclofenac, procyclidine, opioids, midazolam, haloperidol, or anti-secretory drugs. The authors' statement that comfort may let people live longer is based on the cases they observed and is not tested. Assessment in the cancer case was partly by phone over a weekend, and family visits were restricted, which may have limited understanding of the patient's distress. The paper includes author learning points and discussion, which are interpretations rather than measured outcomes.
Declared interests
The authors declared no potential conflicts of interest and received no financial support.
The easy way to misread this
Do not read the improvement as proof that phenobarbitone, diclofenac, or procyclidine works. The patients received many medicines together, and this is a case report series, not a controlled study.