Summary
On the basis of a case study, the complex problems of the final stages of a COPD will be demonstrated and discussed. Dyspnea and anxiousness are the primary symptoms. If they can be adequately brought under control by opiates and benzodiazepines, a palliative sedation is then not necessary. The communicative and ethical demands on the team responsible are high. It is important to be aware of the specific needs of the patient and of his/her family members, and to competently accompany the patient throughout the decision-making process – such as the decision to end respiratory therapy, for example. Clarifying the situation with the patient and finding out his/her wishes, accompanied by the corresponding documentation, is advisable.
Zusammenfassung
Anhand eines Patientenbeispieles werden die komplexen Probleme im terminalen Verlauf einer COPD aufgezeigt und diskutiert. Dyspnoe und Angst sind dabei die vorherrschenden Symptome. Können diese adäquat mit Opioiden und Benzodiazepinen kontrolliert werden, ist eine palliative Sedierung nicht indiziert. Die kommunikativen und ethischen Anforderungen an das betreuende Team sind hoch. Wichtig ist, die spezifischen Bedürfnisse des Patienten und dessen Angehörigen zu kennen und den Patienten in dessen Entscheidungsfindungsprozess – wie hier zum Abbruch der Respiratortherapie – kompetent zu begleiten. Dabei sind Aufklärung, Eruierung des Patientenwillens mit entsprechender Dokumentation empfehlenswert.
Literatur
Binsack T (1997) Respiratorische Symptome. In: Aulbert E, Zech D (1997) Lehrbuch der Palliativmedizin. Schattauer, Stuttgart, S600–S609
McCord M, Cronin-Strubbs D (1992) Operationalizing dyspnea: focus on measurement. Heart Lung 21: 167–169
Steele B, Shaver J (1992) The dyspnea exsperience: nociceptive properties and a model for research and practice. Adv Nurs Sci 15: 64–76
Husebo S, Sandgathe Husebo B (2001) Symptome und Behandlung. In: Die letzten Tage und Stunden. MEDLEX Norwegische Gesundheitsinformation. Oslo, pp 19–20
Twycross R (1993) Symptom control: the problem areas. Palliat Med 7[Suppl 1]: 1–8
Heyse-Moore LH, Poss V, Mullee MA (1991) How much of a problem is dyspnea in advanced cancer. Palliat Med 5: 20–26
Reischl K (2002) Mehr Lebensqualität bei COPD. Ärztewoche 16: 29
Claessens MT, Lynn J, Zhong Z et al (2000) Dying with lung cancer or chronic obstructive pulmonary disease: insights from SUPPORT. J Am Geriatr Soc 48[Suppl]: 146–153
GOLD (2003) The GOLD Workshop Report. Global Strategy for the Diagnosis, Management and Prevention of COPD. Global Initiative for Chronic Obstructive Disease (www.goldcopd.com) (assessed 14 April 2004)
Glaxo Smith Kline Pharma GmbH (2004) Lebensbedrohende Exacerbationen – COPD Patienten verschweigen sie. Österreichische Ärztezeitung 20: 62
Österreichische Gesellschaft für Pneumomologie ÖGP (2004) Konsensus zum Management der chronisch obstruktiven Lungenerkrankungen (COPD). Wien Klin Wochenschr 116: 268–278
Gift AG, Narsavage G (1998) Validity of the numeric rating scale as a measure of dyspnea. Am J Crit Care 7: 200–204
Kellner R, Samet J, Pathak D (1992) Dyspnea, anxiety and depression in chronic respiratory impairment. Gen Hosp Psychiatry 14: 20–28
Gore J, Brophy C, Greenstone M (2000) How well do we care for patients with end-stage COPD? A comparison of palliative care and quality of life in COPD and lung cancer. Thorax 55: 1000–1006
Jonen-Thielemann I (1996) Die Terminalphase. In: Aulbert E, Zech D (Hrsg) Lehrbuch der Palliativmedizin. Schattauer, Stuttgart, pp 678–686
Gliemann S (2003) Workshop "Allgemeine Symptomkontrolle". 3. Fachtagung der Bayerischen Stiftung Hospiz, www.bayerische-stiftung-hospiz.de/texte3/vortrag3_t.htm
Weixler D (2005) Persönliche Mitteilung: Principle of double effect, Jänner 2005
Jennings AJ, Davis AN, Higgins JPT et al (2002) A systematic review of the use of opioids in the management of dyspnea. Thorax 57: 939–944
Campbell ML, Bizek KS, Thill MC (1999) Patient responses during rapid terminal weaning from mechanical ventilation: a prospective study. Crit Care Med 27: 73–77
Weixler D (2003) Palliativmedizin – Sedierung von Sterbenden. In: Weixler D, Paulitsch K (Hrsg) Praxis der Sedierung. Facultas Universitätsverlag, Wien
Albrecht E (2004) Respiratorische Symptome – Dyspnoe. In: Bausewein C, Roller S, Voltz R (Hrsg) Leitfaden Palliativmedizin. Urban & Fischer, München, Jena
Cowan JD, Walsh D (2001) Terminal sedation in palliative medicine – definition and review of the literature. Support Care Cancer 9: 403–407
Müller-Busch C (2004) "Terminale Sedierung" – ein Thema für die Palliativmedizin? Zeitschrift für Palliativmedizin, Georg Thieme, Stuttgart, 29
Hardy J (2000) Sedation in terminally ill patients. Lancet 356: 1866–1867
Goldstein-Shirley J, Fine PG (2001) "Ethics of Total Sedation". Total Sedation Educational Resources Draft, prepared ba a Task Force of the NHPCO Ethics Committee (Session 8A, March 25, 2001): 1–10
Klaschik E (2003) Schmerztherapie und Symptomkontrolle in der Palliativmedizin. In: Husebo S, Klasschik E (Hrsg) Palliativmedizin. Springer, Berlin Heidelberg, S181–S287
Müller-Busch CH (2004) Sterbende sedieren? Zeitschrift für Palliativmedizin 4: 107–112
Morita T, Miyashita M et al (2004) Emotional burden of nurses in palliative sedation therapy. Palliative Medicine 18: 550–557
Morita T, Ikenaga M et al (2004) Concerns of family members of patients receiving palliative sedation therapy. Support Care Cancer
Cherny NI, Portenoy RK (1994) Sedation in the management of refractory symtoms; guidelines for evaluation and treatment. J Pallit Care 10: 31–38
Stone P, Phillips C, Spruyt O et al (1997) A comparison of the use of sedatives in a hospital support team and in a hospice. Palliat Med 11: 140–144
Sykes N (2000) The management of difficult pain and other symptoms at the end of life. Pain in Europe III, advances in pain research and therapy. Nice, France, Abstract ORC/O6: 71–72
Fainsinger RL, Bercovici M, Bengtson K et al (2000) A multicentre international study of sedation for uncontrolled symptoms in terminally ill patients. Palliat Med 14: 257–265
Roy DJ (1997) Grundlagen der Palliativmedizin. In: Aulbert E, Zech D (Hrsg) Lehrbuch der Palliativmedizin. Schattauer, Stuttgart
Materstvedt LJ, Clark D et al (2003) Euthanasia and physician-assisted suicide: a view from an EAPC Ethics Task Force. Palliative Medicine 17: 97–101
Beleites M (1997) Entwurf der Bundesärztekammer zur ärztlichen Sterbebegleitung und den Grenzen zumutbarer Behandlung. Dtsch Ärzteblatt 94: 1064–1065
Eser A et al (1989) Lexikon Medizin-Ethik-Recht. Herder, Freiburg i. Breisgau
Meran J (2003) Lebensqualität. Aussichtslosigkeit und Therapiebegrenzung. In: Bonelli J (Hrsg) Imago Hominis. Palliativmedizin I, Imabe, Wien, S19–S28
Shee C: Respiratory disease. In: Addington-Hall J, Higginson I (eds) Palliative Care for Non-Cancer Patients. Oxford University Press, Oxford, pp 20–27
Breen D, Churches D, Hawker F et al (2002) Acute respiratory failure secondary chronic obstructive pulmonary disease treated in an intensive care unit: a long term follow up study. Thorax 57: 29–33
Seneff MG, Wagner DP, Wagner RP et al (1995) Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbations of chronic obstructive pulmonary disease. JAMA 274: 1852–1857
Breen D, Churches D, Hawker F et al (2002) Acute respiratory failure secondary chronic obstructive pulmonary disease treated in an intensive care unit: a long term follow up study. Thorax 57: 29–33
Nevins ML, Epstein SK (2001) Predictors of outcome for patients with COPD requiring invasive mechanical ventilation. Chest 119: 1840–1849
Plant PK, Owen JL, Elliott MW (2000) Early use of non invasive ventilation for acute exacerbations of chronic pulmonary disease on general respiratory wards: a multicentre randomized controlled trial. Lancet 355: 1931–1935, 1936
Murtagh F, Preston M, Higginson I (2004) Patterns of dying: palliative care for non malignant disease. Clin Med 4: 39–44
Wenger NS, Phillips RS, Teno JM, Oye RK, Dawson NV, Liu H, Califf R, Layde P, Hakim R, Lynn J (2000) Physician understanding of patient resucitation preference: imsights and clinical implications. J Am Geritr Soc 48[5 Suppl]: 44–51
Rhodes P (1999) Palliative care: the situation of people with chronic respiratory disease. Br J Community Nurs 4: 131–136
Elkington H, White P, Higgs R, Johnson Pettinari C (2001) GP's views of discussions of prognosis in severe COPD. Fam Pract 18: 440–444
Lynn J, Ely EW, Zhong Z et al (2000) Living and dying with chronic obstructive pulmonary disease. J Am Geriatr Soc 48: 91–100
Blackler L, Mooney C, Jones C (2002) Palliative care in the management of chronic obstructive pulmonary disease. Brit J Nursing 13: 518–521
Simonds AK (2003) Occasioinal review: Ethics and decision in making in end stage lung disease. Thorax 58: 272–277
Schneidermann LJ, Gilmer T, Teetzel HD (2000) Impact of ethics consultations in the intensive csre setting: arandomised, controlled trial. Crit Care Med 28: 3920–3924
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Hörfarter, B. Symptomkontrolle und ethische Aspekte im terminalen Verlauf einer COPD. Wien Med Wochenschr 156, 275–282 (2006). https://doi.org/10.1007/s10354-006-0289-2
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DOI: https://doi.org/10.1007/s10354-006-0289-2