Background Non-invasive pulmonary support (NIPS), (CPAP or NIV), is available to patients with Covid-19 and a ward based ceiling of treatment. Evidence demonstrate a 50% survival with NIPS in this cohort. We, and our respiratory colleagues, were interested to understand the experience of dying in this context.
Method This was a retrospective case note review. Aims and objectives include:
To describe the symptoms experienced, medications required and reasons for withdrawal in patients dying of covid–19 following treatment with NIPS
To evaluate care against the five priorities (NICE guideline (NG142)).
Results 18 patients were included for analysis. The majority were aged over 80 (67%). All patients experienced breathlessness when dying, and seventeen had agitation or delirium. Twelve patients (66%) required a regular benzodiazepine, either alone (22%) or in combination with an opioid (45%). Two patients (11%) were treated with only an opioid. The doses of opioids and midazolam were relatively small - most commonly 10 mg. 66% of patients received <3 as required doses of opioid or midazolam in the final 24 hours. The commonest reasons for withdrawal were the patient stopping tolerating treatment (56%), and treatment failure (28%). No patients died within three hours of withdrawal, with the majority dying six hours to two days later. In 17 cases (94%) it was recognised and documented that the patient was sick enough to die. This was communicated to the patient and/or their family in all 94%. All patients had a DNACPR and Treatment Escalation Plan. 94% of families were offered to visit their dying relative, this was taken up in 44% of cases.
Conclusions Good end of life care is achievable in the context of patients with Covid-19, receiving NIPs. Key learning includes:
• The need to regularly review symptoms and consider increasing background sc infusions more frequently than our usual practice of every 24 hrs.
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