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Fluid Management in Palliative Care

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Body Fluid Management

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Abstract

Palliative sedation is a medical procedure in which consciousness is reduced or abolished, as the only therapeutic resource to relieve refractory symptoms that are intolerable for the patient. It is carried out through gradual titration of a sedative accompanied by periodic monitoring of the patient’s vital signs, level of sedation, and degree of symptom relief. A team of experts in palliative care must perform this procedure, taking into account the indication and timing and the complete history of the patient. Ethical principles of proportionality, beneficence, and non-malfeasance, as well as the principle of patient autonomy are important considerations.

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References

  1. Nathan I Cherny, Lukas Radbruch and The Board of the European Association for Palliative Care European Association for Palliative Care (EAPC) (2009) recommended framework for the use of sedation in palliative care. Palliat Med 23:581

    Article  PubMed  Google Scholar 

  2. Maltoni M (1999) Successful validation of the palliative prognostic score (Pap Score) in terminally ill cancer patients. J pain symptom manage 17:240–247

    Article  PubMed  CAS  Google Scholar 

  3. Morita T (1999) The palliative prognostic index: a scoring system for survival prediction of terminally ill cancer patients. Support care cancer 7:128–133

    Article  PubMed  CAS  Google Scholar 

  4. Morita T (2005) Ethical validity of palliative sedation therapy: a multicenter, prospective, observational study conducted on specialized palliative care units in Japan. Journal of Pain and Symptom Management 30:308–319

    Article  PubMed  Google Scholar 

  5. Boyle J (2004) Medical ethics and double effect: the case of terminal sedation. Theoretical Medicine 25:51–60

    Article  Google Scholar 

  6. Juth N (2010) European Association for Palliative Care (EAPC) framework for palliative sedation: an ethical discussion. BMC Palliative Care 9:20

    Article  PubMed  Google Scholar 

  7. Olsen ML (2010) Ethical decision making with end-of-life care: palliative sedation and withholding or withdrawing life-sustaining treatments. Mayo Clin Proc 85(10):949–954

    Article  PubMed  Google Scholar 

  8. Claessens P, Menten J, Schotsmans P, Broeckaert B (2008) Palliative sedation: a review of the research literature. J Pain Symptom Manage 36:310–333

    Article  PubMed  Google Scholar 

  9. Rietjens JA (2008) Palliative sedation in a specialized unit for acute palliative care in a cancer hospital: comparing patients dying with and without palliative sedation. J Pain Symptom Manage 36:228–234

    Article  PubMed  Google Scholar 

  10. Stone P, Phillips C, Spruyt O, Waight C (1997) A comparison of the use of sedatives in a hospital support team and in a hospice. Palliat Med 11:140–4

    Article  PubMed  CAS  Google Scholar 

  11. Chiu TY, Hu WY, Lue BH, Cheng SY, Chen CY (2001) Sedation for refractory symptoms of terminal cancer patients in Taiwan. J Pain Symptom Manage 21:467–472

    Article  PubMed  CAS  Google Scholar 

  12. Sykes N, Thorns A (2003) Sedative use in the last week of life and the implications for end-of-life decision making. Arch Intern Med 163:341–344

    Article  PubMed  Google Scholar 

  13. Maltoni M, Pittureri C, Scarpi E et al (2009) Palliative sedation therapy does not hasten death: results from a prospective multicentre study. Ann Oncol 20:1163–1169

    Article  PubMed  CAS  Google Scholar 

  14. Morita T, Chinone Y, Ikenaga M et al (2005) Efficacy and safety of palliative sedation therapy: a multicenter, prospective, observational study conducted on specialized palliative care units in Japan. J Pain Symptom Manage 30:320–328

    Article  PubMed  Google Scholar 

  15. Dunlop RJ, Ellershaw JE, Baines MJ, Sykes N, Saunders CM (1995) On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far? A reply. Journal of medical ethics 21:141–143

    Article  PubMed  CAS  Google Scholar 

  16. Bruera E, Belzile M, Watanabe S, Fainsinger RL (1996) Volume of hydration in terminal cancer patients. Support Care Cancer 4:147–150

    Article  PubMed  CAS  Google Scholar 

  17. Ciccone A, Allegra JR, Cochrane DG, Cody RP, Roche LM (1998) Age related differences in diagnoses within the elderly population. Am J Emerg Med 16:43–48

    Article  PubMed  CAS  Google Scholar 

  18. Hoffman NB (1991) Dehydration in the elderly: insidious and manageable. Geriatrics 46:35–38

    PubMed  CAS  Google Scholar 

  19. Lavizzo-Mourey R, Johnson J, Stolley P (1988) Risk factors for dehydration among elderly nursing home residents. J Am Geriatr Soc 36:213–218

    PubMed  CAS  Google Scholar 

  20. Seymour DG, Henschke PJ, Cape RD, Campbell AJ (1980) Acute confusional states and dementia in the elderly: the roles of dehydration/volume depletion, physical illness and age. Age Ageing 9:137–146

    Article  PubMed  CAS  Google Scholar 

  21. Warren JL, Bacon WE, Harris T et al (1994) The burden and outcomes associated with dehydration among US elderly, 1991. Am J Public Health 84:1265–1269

    Article  PubMed  CAS  Google Scholar 

  22. Oskvig RM (1999) Special problems in the elderly: the aging kidney and liver. Chest 115(5 suppl):158S–164S

    Article  PubMed  CAS  Google Scholar 

  23. Dalal S, Bruera E (2004) Dehydration in cancer patients: to treat or not to treat. J Support Oncol 2:467–487

    PubMed  Google Scholar 

  24. Bruera E, Franco JJ, Maltoni M, Watanabe S, Suarez-Almazor M (1995) Changing patterns of agitated impaired mental status in patients with advanced cancer: association with cognitive monitoring, hydration, and opioid rotation. J Pain Symptom Manage 10:287–291

    Article  PubMed  CAS  Google Scholar 

  25. Inouye SK, Bogardus ST Jr, Charpentier PA et al (1999) A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 340:669–676

    Article  PubMed  CAS  Google Scholar 

  26. Agostini JV, Leo-Summers LS, Inouye SK (2001) Cognitive and other adverse effects of diphenhy-dramine use in hospitalized older patients. Arch Intern Med 161:2091–2097

    Article  PubMed  CAS  Google Scholar 

  27. Gagnon P, Allard P, Mâsse B, DeSerres M (2000) Delirium in terminal cancer: a prospective study using daily screening, early diagnosis, and continuous monitoring. J Pain Symptom Manage 19:412–426

    Article  PubMed  CAS  Google Scholar 

  28. Maddocks I, Somogyi A, Abbott F, Hayball P, Parker D (1996) Attenuation of morphine-induced delirium in palliative care by substitution with infusion of oxycodone. J Pain Symptom Manage 12:182–189

    Article  PubMed  CAS  Google Scholar 

  29. Tuma R, DeAngelis LM (2000) Altered mental status in patients with cancer. Arch Neurol 57:1727–1731

    Article  PubMed  CAS  Google Scholar 

  30. Breitbart W, Gibson C, Tremblay A (2002) The delirium experience: delirium recall and delirium-related distress in hospitalized patients with cancer, their spouses/caregivers, and their nurses. Psychosomatics 43:183–194

    Article  PubMed  Google Scholar 

  31. Fainsinger RL, Bruera E (1997) When to treat dehydration in a terminally ill patient. Support Care 5:205–11

    Article  CAS  Google Scholar 

  32. Ellershaw JE, Sutcliffe JM, Saunders CM (1995) Dehydration and the dying patient. Journal of pain and symptom management 10:192–197

    Article  PubMed  CAS  Google Scholar 

  33. Burge FI (1993) Dehydration symptoms of palliative care cancer patients. Journal of pain and symptom management 8:454–464

    Article  PubMed  CAS  Google Scholar 

  34. Waller A, Adunski A, Hershkowitz M (1991) Terminal dehydration and intravenous fluids. Lancet 337:745

    Article  PubMed  CAS  Google Scholar 

  35. Wildiers H, Menten J (2002) Death rattle: prevalence, prevention and treatment. J Pain Symptom Manage 23:310–7

    Article  PubMed  Google Scholar 

  36. Fainsinger R (2006) Non-oral hydration in palliative care #133. J Palliat Med 9:206–7

    Article  PubMed  Google Scholar 

  37. Krzywda EA (1999) Predisposing factors, prevention, and management of central venous catheter occlusions. J Intraven Nurs 22(6 suppl):S11–S17

    PubMed  CAS  Google Scholar 

  38. Slesak G, Schnurle JW, Kinzel E, Jakob J, Dietz PK (2003) Comparison of subcutaneous and intravenous rehydration in geriatric patients: a randomized trial. J AmGeriatr Soc 51:155–160

    Article  Google Scholar 

  39. Schen RJ, Singer-Edelstein M (1981) Subcutaneous infusions in the elderly. J Am Geriatr Soc 29:583–585

    PubMed  CAS  Google Scholar 

  40. O’Keeffe ST, Lavan JN (1996) Subcutaneous fluids in elderly hospital patients with cognitive impairment. Gerontology 42:36–39

    Article  CAS  Google Scholar 

  41. Bruera E, Brenneis C, Michaud M et al (1988) Use of the subcutaneous route for the administration of narcotics in patients with cancer pain. Cancer 62:407–411

    Article  PubMed  CAS  Google Scholar 

  42. Fainsinger RL, Bruera E (1991) Hypodermoclysis (HDC) for symptom control versus the Edmonton Injector (EI). J Palliat Care 7:5–8

    Google Scholar 

  43. Bruera E, Schoeller T, Pruvost M (1994) Proctoclysis for hydration of terminal cancer patients. Lancet 344:1699

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Intensive Care Department, University School of Medicine Campus Bio-Medico of Rome, Rome, Italy

    Massimiliano Carassiti

Authors
  1. Massimiliano Carassiti
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  2. Annalaura Di Pumpo
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  3. Felice Eugenio Agrò
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Correspondence to Massimiliano Carassiti .

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Editors and Affiliations

  1. Intensive Care and Pain Management Department, University School of Medicine Campus Bio-Medico of Rome, Rome, Italy

    Felice Eugenio Agrò MD (Commander to the Order of Merit of the Italian Republic, Full Professor of Anesthesia and Intensive Care, Chairman of Postgraduate School of Anesthesia and Intensive Care, Director of Anesthesia) (Commander to the Order of Merit of the Italian Republic, Full Professor of Anesthesia and Intensive Care, Chairman of Postgraduate School of Anesthesia and Intensive Care, Director of Anesthesia)

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Carassiti, M., Di Pumpo, A., Agrò, F.E. (2013). Fluid Management in Palliative Care. In: Agrò, F.E. (eds) Body Fluid Management. Springer, Milano. https://doi.org/10.1007/978-88-470-2661-2_16

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  • DOI: https://doi.org/10.1007/978-88-470-2661-2_16

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2660-5

  • Online ISBN: 978-88-470-2661-2

  • eBook Packages: MedicineMedicine (R0)

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