Abstract：
CONTEXT:Most deaths in intensive care units occur after limitation or withdrawal of life-sustaining therapies. Often these patients require opioids to assuage suffering; yet, little has been documented concerning their use in the medical intensive care unit. OBJECTIVES:To determine the dose and factors influencing the use of opioids in patients undergoing terminal withdrawal of mechanical ventilation in this setting. METHODS:Data were prospectively collected from 74 consecutive patients expected to die soon after extubation. The doses of morphine, effect on time to death, and relation of dose to diagnostic categories were analyzed. RESULTS:The mean (±standard deviation) dose of morphine given to patients during the last hour of mechanical ventilation was 5.3mg/hour. Patients dying after extubation received 10.6 mg/hour just before death. Immediately before extubation, the dose correlated directly with chronic medical opioid use and sepsis with respiratory failure and inversely with coma after cardiopulmonary resuscitation or a primary neurological event. After terminal extubation, the final morphine dose correlated directly with the presence of sepsis with respiratory failure and chronic pulmonary disease. The mean time to death after terminal extubation was 152.7 ± 229.5 minutes without correlation with premorbid diagnoses. After extubation, each 1mg/hour increment of morphine infused during the last hour of life was associated with a delay of death by 7.9 minutes (P = 0.011). CONCLUSION:Premorbid conditions may influence the dose of morphine given to patients undergoing terminal withdrawal of mechanical ventilation. Higher doses of morphine are associated with a longer time to death.
journal_name
J Pain Symptom Managejournal_title
Journal of pain and symptom managementauthors
Mazer MA,Alligood CM,Wu Qdoi
10.1016/j.jpainsymman.2010.10.256subject
Has Abstractpub_date
2011-07-01 00:00:00pages
44-51issue
1eissn
0885-3924issn
1873-6513pii
S0885-3924(10)01025-0journal_volume
42pub_type
杂志文章abstract：CONTEXT:The gap between informal caregivers' expectations of caregiving at the end of life and their actual caregiving experience has important affective and behavioral consequences. OBJECTIVES:This study analyzes for the first time the characteristics of those caregivers who report a worse or much worse than expected...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2015.04.017
更新日期：2015-10-01 00:00:00
abstract：:The intravenous (i.v.) administration of opioids to neonates is a common method of providing analgesia in the intensive care setting. This paper reviews and critiques the studies that have investigated this intervention. The studies are grouped into four major areas: pharmacokinetic studies; i.v. opioids for anesthesi...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章,评审
doi：10.1016/S0885-3924(97)00272-8
更新日期：1998-01-01 00:00:00
abstract：CONTEXT:Dyspnea is a frequently reported and highly distressing symptom for persons nearing end of life, affecting the quality of living and dying. OBJECTIVES:This study described health and clinical characteristics of persons experiencing dyspnea who receive palliative home care services and identified factors affect...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章,多中心研究
doi：10.1016/j.jpainsymman.2015.06.016
更新日期：2015-12-01 00:00:00
abstract：:As more individuals are being treated for cancer with high-dose therapy and autologous stem cell rescue (ASCR), there is growing interest in treatment side effects and their impact on quality of life. The primary aim of this study was to determine if the severity of fatigue and its impact on quality of life is signifi...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/s0885-3924(99)00007-x
更新日期：1999-05-01 00:00:00
abstract：:This trial compared pain, quality of life, and analgesic use in a sample of patients with cancer pain (n=24) who received either standard opioid management plus rest (Arm A) or standard opioid management plus Reiki (Arm B). Participants either rested for 1.5 hr on Days 1 and 4 or received two Reiki treatments (Days 1 ...
journal_title：Journal of pain and symptom management
pub_type： 临床试验,杂志文章
doi：10.1016/s0885-3924(03)00334-8
更新日期：2003-11-01 00:00:00
abstract：:After years of second-class status, supportive care is increasingly being recognized for its importance. Included in this recognition is a concern for making more explicit the long-held conviction within medicine that no goal can logically be more important than optimal patient functioning and well-being. This effort ...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/0885-3924(94)90129-5
更新日期：1994-04-01 00:00:00
abstract：:Increasingly in the U.S., health care clinicians fail to recognize and accept when curative goals are no longer realistic. At this point, futile efforts at cure can fuel false hopes in patients and their loved ones. The clinician's need to be "doing something" may result in treatment that violates the dignity and well...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2012.07.010
更新日期：2012-10-01 00:00:00
abstract：:Assessing quality of care at the end of life involves measurements in several domains-use of evidence-based guidelines, patient and family satisfaction, quality of life, and incidence of adverse events, among others. There are several different data sources from which to calculate quality measures. Each data source ha...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/s0885-3924(01)00329-3
更新日期：2001-09-01 00:00:00
abstract：CONTEXT:Longitudinal studies that have described the trajectory of familial caregiving and bereavement outcomes have often failed to include a comprehensive range of carer and caregiving variables or any patient assessments, and only a few have used a recognized structured interview for psychiatric disorders. OBJECTIV...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2010.03.014
更新日期：2010-12-01 00:00:00
abstract：:Methylnaltrexone, a peripherally acting mu-opioid receptor antagonist with restricted ability to cross the blood-brain barrier, reverses opioid-induced constipation (OIC) without affecting analgesia. A double-blind study in patients with advanced illness and OIC demonstrated that methylnaltrexone significantly induced...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.jpainsymman.2009.02.234
更新日期：2009-11-01 00:00:00
abstract：:PC-FACS(FastArticleCriticalSummaries for Clinicians inPalliativeCare) provides hospice and palliative care clinicians with concise summaries of the most important findings from more than 100 medical and scientific journals. If you have colleagues who would benefit from receiving PC-FACS, please encourage them to join ...
journal_title：Journal of pain and symptom management
pub_type： 评论,杂志文章
doi：10.1016/j.jpainsymman.2016.05.001
更新日期：2016-06-01 00:00:00
abstract：CONTEXT:Using mortality rates to measure hospital quality presumes that hospital deaths are medical failures. To be a fair measure of hospital quality, hospital mortality measures must take patient-level factors, such as goals of care, into account. OBJECTIVES:To answer questions about how hospital mortality rates are...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2010.07.005
更新日期：2010-12-01 00:00:00
abstract：CONTEXT:There is an increasing use of palliative care units (PCUs) for the treatment of terminally ill cancer patients. Thus, it is important to evaluate the care and quality of life of terminally ill cancer patients treated in PCUs so that improvements can be made. Limited research has investigated the quality of dyin...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2012.04.010
更新日期：2013-04-01 00:00:00
abstract：:Despite decades of research, national mandates, and widespread implementation of guidelines, recent reports suggest that the quality of pain assessment and management in hospitalized children remains suboptimal. The mismatch between what is advocated and what is done in practice has led experts to argue for a conceptu...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章,评审
doi：10.1016/j.jpainsymman.2011.09.005
更新日期：2012-09-01 00:00:00
abstract：CONTEXT:Mindfulness-based interventions have been receiving growing attention in cancer care. OBJECTIVES:The purpose of this randomized controlled trial is to examine the effectiveness of mindfulness-based cognitive therapy (MBCT) for psychological distress (anxiety and depression), fear of cancer recurrence (FCR), fa...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2020.02.017
更新日期：2020-08-01 00:00:00
abstract：CONTEXT:Adequate symptom management is essential to ensure quality cancer care, but symptom management is not always evidence based. Adapting and automating national guidelines for use at the point of care may enhance use by clinicians. OBJECTIVES:This article reports on a process of adapting research evidence for use...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2013.01.016
更新日期：2013-12-01 00:00:00
abstract：:Recent research has shown that the psychostimulant drug dextroamphetamine can increase the analgesia produced by opioids. Despite the strong, positive results in human clinical subjects and in animals, this combination is rarely used in clinical practice. The purpose of this paper is to investigate whether the psychos...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/s0885-3924(98)00085-2
更新日期：1998-10-01 00:00:00
abstract：:Breakthrough pain in patients with cancer is common, often unpredictable, and can rapidly become severe. Treatment using the oral administration of opioids is not optimal due to the slow onset of pain relief. Nasal administration of analgesics potentially offers more rapid pain relief. This study investigates the tole...
journal_title：Journal of pain and symptom management
pub_type： 临床试验,杂志文章
doi：10.1016/s0885-3924(02)00522-5
更新日期：2002-12-01 00:00:00
abstract：CONTEXT:Oncology patients with persistent pain treated in outpatient settings and their family caregivers have significant responsibility for managing pain medications. However, little is known about their practical day-to-day experiences with pain medication management. OBJECTIVES:The aim was to describe day-to-day p...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.jpainsymman.2013.12.242
更新日期：2014-11-01 00:00:00
abstract：CONTEXT:Recent analyses of Medicare data show decreases over time in intensity of end-of-life care. Few studies exist regarding trends in intensity of end-of-life care for those under 65 years of age. OBJECTIVES:To examine recent temporal trends in place of death, and both hospital and intensive care unit (ICU) utiliz...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2017.08.032
更新日期：2018-01-01 00:00:00
abstract：:Few studies have evaluated sex differences in the prevalence, severity, and correlates of fatigue at the end of life. The Brief Fatigue Inventory, McGill Quality of Life (MQOL) Questionnaire, and Karnofsky Performance Scale were administered at two-week intervals to 102 patients in a home palliative program. Outcomes ...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2006.09.019
更新日期：2007-04-01 00:00:00
abstract：:Decisions about care at the end of life are not only influenced by doctor-patient-family relationships and physician practice, but also by institutional "culture." An institutional assessment of the quality of care provided to dying hospitalized patients was undertaken to characterize and identify factors influencing ...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/s0885-3924(02)00494-3
更新日期：2002-09-01 00:00:00
abstract：CONTEXT:In 2010, California launched Partners for Children (PFC), a pediatric palliative care pilot program offering hospice-like services for children eligible for full-scope Medicaid delivered concurrently with curative care, regardless of the child's life expectancy. OBJECTIVES:We assessed the change from before PF...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2016.02.020
更新日期：2016-09-01 00:00:00
abstract：:Actigraphy has become a valuable clinical and research tool to objectively evaluate sleep, daytime activity, and circadian activity rhythms in healthy individuals as well as persons with primary and comorbid insomnia. However, procedures used for sampling, data processing, and analysis are not consistently reported in...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2007.10.008
更新日期：2008-08-01 00:00:00
abstract：CONTEXT:Measuring What Matters (MWM) prioritizes quality measures in palliative care practice. Hematologic malignancy patients are less likely to access palliative care, yet little is known about their unique needs. Differences in MWM adherence may highlight opportunities to improve palliative care in hematology. OBJE...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章,多中心研究
doi：10.1016/j.jpainsymman.2016.09.004
更新日期：2016-12-01 00:00:00
abstract：CONTEXT:Efforts in developing useful tools to properly identify the end-of-life trajectory of patients with advanced medical diseases have been made, but the calibration and/or discriminative power of these tools has not been optimal. OBJECTIVES:Our objective was to develop a new, reliable prognostic tool to identify ...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章,多中心研究
doi：10.1016/j.jpainsymman.2013.04.011
更新日期：2014-03-01 00:00:00
abstract：CONTEXT:Limited information is available about lung cancer patients' symptoms in the pre- and postoperative periods. OBJECTIVES:Study purposes were to evaluate for changes in symptom occurrence and severity from the preoperative period to five months after surgery and to evaluate for predictors of the occurrence and t...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2014.11.297
更新日期：2015-06-01 00:00:00
abstract：CONTEXT:Sleep disturbances are frequent in cancer patients during chemotherapy; the contributory role of restless legs syndrome (RLS) in this setting has never been assessed. OBJECTIVES:This study investigated the role of RLS in causing sleep disturbances and altering the quality of life in cancer patients during chem...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2012.06.018
更新日期：2013-07-01 00:00:00
abstract：:Two young women with chronic nausea and vertigo caused by multiple sclerosis responded to the introduction and maintenance of the 5HT3 receptor antagonist, ondansetron. Palliative care is a neglected aspect of management of degenerative neurological diseases and these cases highlight the approaches that may be used to...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/s0885-3924(00)00205-0
更新日期：2000-11-01 00:00:00
abstract：:Fatigue is among the most distressing symptoms experienced by terminally ill cancer patients. It is necessary to clarify factors correlated with fatigue to develop effective management strategies. A consecutive sample of cancer patients newly registered in the Palliative Care Unit (PCU) was assessed on three occasions...
journal_title：Journal of pain and symptom management
pub_type： 杂志文章
doi：10.1016/j.jpainsymman.2007.06.014
更新日期：2008-05-01 00:00:00
