Wiener medizinische Wochenschrift
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Wien Med Wochenschr · Dec 2009
Case Reports[Invasive and non-invasive ventilation in conflict with best palliative care in severe COPD].
This example of an 80-year-old patient with severe lung disease and respiratory failure demonstrates the difficult relationship between the patient's needs, physical symptoms, and social problems. This man decides after a prolonged and difficult in-patient treatment actively for home ventilation rather than die of respiratory failure. ⋯ It requires professional communication and support to gain the acceptance of family and caregivers for home ventilation. A survey of existing data on end of life decision-making in end-stage lung disease is given.
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Wien Med Wochenschr · Dec 2009
ReviewPathophysiology and diagnosis of dyspnea in patients with advanced cancer.
The reported prevalence of dyspnea in patients with various cancers ranges from 19% to 64%. For optimal clinical management of dyspnea in cancer patients, accurate diagnosis of the underlying cause and thorough understanding of the pathomechanisms of dyspnea seems mandatory. ⋯ These should be performed immediately to enable quick treatment decisions. In addition, self assessment of the intensity of dyspnea by the patient may help to assess patient's needs as soon as possible.
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Wien Med Wochenschr · Dec 2009
ReviewManagement of dyspnea in patients with chronic obstructive pulmonary disease.
A progressive and debilitating illness, chronic obstructive pulmonary disease (COPD) has major worldwide impact. In addition to the care for underlying causes of disease, COPD treatment involves palliative intervention to address associated symptoms; in later stages of disease, when the underlying disease has been maximally treated, symptom management assumes primacy as the goal of care. Dyspnea is the most distressing symptom experienced by COPD patients. ⋯ Numerous pharmacologic and non-pharmacologic interventions are available to achieve these goals, but supporting evidence is variable. This review summarizes options for managing refractory dyspnea in COPD patients, referring to the available evidence and highlighting areas for further investigation. Topics include oxygen, opioids, psychotropic drugs, inhaled frusemide, Heliox28, nutrition, psychosocial support, and breathing techniques.
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Wien Med Wochenschr · Dec 2009
ReviewManagement of refractory breathlessness in patients with advanced cancer.
Breathlessness is a common and distressing symptom in advanced cancer. Management comprises non-pharmacological and pharmacological interventions, which are best combined. ⋯ Opioids are the drugs of choice for pharmacological management of breathlessness. There is currently not enough evidence to support the routine use of benzodiazepines, other anxiolytics, antidepressants, phenothiazines, inhaled furosemide and oxygen.
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Wien Med Wochenschr · Oct 2009
Review[Prevention of perioperative venous thromboembolism in children].
Venous thromboembolic events (VTE) occur in children at the time of surgery. Few guidelines about how to assess the risk and provide prophylaxis have been developed and published so far. It is uncertain if any of these guidelines have been adopted into clinical practice. ⋯ Decision for VTE prophylaxis must widely be based on individual risk assessment by experienced physicians. Newly developed scores and guidelines may provide assistance. Well designed clinical studies in children that provide proper evidence on risk assessment for VTE at the time of surgery and investigate safety and efficacy of antithrombotic prophylaxis/treatment are urgently needed.