Palliative Care in Advanced Organ Failure

Authors

  • Manuel Araújo Serviço de Medicina Interna, Centro Hospitalar Lisboa Ocidental, Hospital São Francisco Xavier, Lisboa, Portugal
  • Isabel Galriça Neto Serviço da Unidade de Cuidados Continuados e Paliativos, Hospital da Luz, Lisboa, Portugal
  • Rita Abril Serviço da Unidade de Cuidados Continuados e Paliativos, Hospital da Luz, Lisboa, Portugal
  • Rui Rodrigues Serviço da Unidade de Cuidados Continuados e Paliativos, Hospital da Luz, Lisboa, Portugal

DOI:

https://doi.org/10.24950/rspmi/51/2017

Keywords:

Analgesics, Opioid/therapeutic use, Heart Failure, Liver Failure, Palliative Care, Renal Insufficiency, Respiratory Insufficiency

Abstract

The goal of palliative care is to relieve suffering. In pathologies with less predictable evolution, like chronic organ failures, this
intervention is not always performed. Knowing how to identify the patients in need of this special care is essential. In this review we highlight the main symptoms related to each organ failure as well as treatment and acting options. Due to
the overlap of certain symptoms in terminally ill patients, like pain, dyspnea and diarrhea, we also focus on the advantage provided by the opioid class that effectively covers all these symptoms as well as certain considerations that need to be taken into account in their use in specific organ failures. The particularities of the use of opioids in patients with organ shortages are also addressed.

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References

Lunney JR, Lynn J, Foley DJ, Lipson S, Guralnik JM. Patterns of functional decline at the end of life. JAMA. 2003 14;289:2387-92.

Gomes B, Sarmento VP, Ferreira PL, Higginson IJ. Epidemiological study of place of death in Portugal in 2010 and comparison with the preferences of the Portuguese population. Acta Med Port. 2013;26:327-34

Murtagh FE, Bausewein C, Verne J, Groeneveld EI, Kaloki YE, Higginson IJ. How many people need palliative care? A study developing and comparing methods for population-based estimates. Palliat Med. 2014; 28:49-58.

Gómez-Batiste X, Martínez-Muñoz M, Blay C, Amblàs J, Vila L, Costa X, et al. Identifying patients with chronic conditions in need of palliative care in the general population: development of the NECPAL tool and preliminary prevalence rates in Catalonia. BMJ Support Palliat Care. 2013;3:300-8.

Thomas K.Prognostic Indicator Guidance. 4th ed.. Shropshire:The Gold Standards Framework Centre In End of Life Care CIC; 2011.

Solano JP, Gomes B, Higginson IJ. A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease andrenal disease. J Pain Symptom Manage. 2006 ;31:58-69.

Rogal SS, Winger D, Bielefeldt K, Szigethy E. Pain and opioid use in chronic liver disease. Dig Dis Sci. 2013;58:2976-85.

Mullish BH, Kabir MS, Thursz MR, Dhar A. Review article: depression and the use of antidepressants in patients with chronic liver disease or liver transplantation. Aliment Pharmacol Ther. 2014;40:880-92.

Rogal SS, Landsittel D, Surman O, Chung RT, Rutherford A. Pretransplant depression, antidepressant use, and outcomes of orthotopic liver transplantation. Liver Transpl. 2011;17:251-60.

Kaltsakas G, Antoniou E, Palamidas AF, Gennimata SA, Paraskeva P, Smyrnis A, et al. Dyspnea and respiratory muscle strength in end-stage liver disease. World J Hepatol. 2013;5:56-63.

Ferreira PP, Camara EJ, Paula RL, Zollinger CC, Cavalcanti AR, Bittencourt PL. Prevalence of hepatopulmonary syndrome in patients with decompensated chronic liver disease and its impact on short-term survival. Arq Gastroenterol. 2008;45:34-7.

Córdoba J, Cabrera J, Lataif L, Penev P, Zee P, Blei AT. High prevalence of sleep disturbance in cirrhosis. Hepatology. 1998;27:339-45.

Arisar FA, Khan SB, Umar A. Hepatic encephalopathy in chronic liver disease; predisposing factors in a developing country. Asian J Med Sci. 2015;6:36-43.

Bruix J, Castells A, Calvet X, Feu F, Bru C, Solé M, Bruguera M, Rodés J. Diarrhea as a presenting symptom of hepatocellular carcinoma. Dig Dis Sci. 1990;35:681-5.

Poonja Z, Brisebois A, Van Zanten SV, Tandon P, Meeberg G, Karvellas CJ. Patients with cirrhosis and denied liver transplants rarely receive adequate palliative care or appropriate management. Clin Gastroenterol Hepatol. 2014;12:692-8.

Swain MG. Fatigue in liver disease: pathophysiology and clinical management. Can J Gastroenterol. 2006;20:181-8.

World Health Organization, International Association for Hospice and Palliative Care. Essential Medicines in Palliative Care: Executive

Summary. Geneve: WHO, IAHPC; 2013.

Gallardo R, Gamboa F. Uso de la vía subcutânea en cuidados paliativos. Madrid: Monografias Secpal; 2013.

Goodlin SJ. Palliative care in congestive heart failure. J Am Coll Cardiol. 2009;54:386-96.

Lanken PN, Terry PB, Delisser HM, Fahy BF, Hansen-Flaschen J, Heffner JE,et al. An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses. Am J Respir Crit Care Med. 2008;177:912-27.

Kane P, Lodge P, Hopkins K, Greenslade L, Tookman A. Living and dying well with end-stage liver diseasese: time for palliative care? Hepatology. 2013;57:2092.

Chandok N, Watt KD. Pain management in the cirrhotic patient: the clinical challenge. Mayo Clin Proc. 2010;85:451-8.

SEccareccia D, Gebara N. Pruritus in palliative care: Getting up to scratch. Can Fam Physician. 2011;57:1010-3

O´Connor NR, Corcoran AM. End-stage renal disease: symptom mangement and advance care planning. Am Fam Physician. 2012;85:705-10.

Mahler DA. Opioids for refractory dyspnea. Expert Rev Respir Med. 2013;7:123-34.

Wiseman R, Rowett D, Allcroft P, Abernethy A, Currow DC. Chronic refractory dyspnoea-evidence based management. Aust Fam Physician. 2013;42:137-40.

Abernethy AP, Currow DC, Frith P, Fazekas BS, Mchugh A, Bui C. Randomised, double Blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea. BMJ. 2003;327:523-8.

Johnson S. Opioid safety in patients with renal or hepatic dysfunction. Pain Treatment Topics. 2007. [accessed June 15, 2016] Available from: http://paincommunity.org/blog/wp-content/uploads/Opioids-Renal-Hepatic-Dysfunction.pdf.

Additional Files

Published

2017-09-29

How to Cite

1.
Araújo M, Galriça Neto I, Abril R, Rodrigues R. Palliative Care in Advanced Organ Failure. RPMI [Internet]. 2017 Sep. 29 [cited 2024 Dec. 18];24(3):228-34. Available from: https://revista.spmi.pt/index.php/rpmi/article/view/720

Issue

Section

Review Articles