Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2020
[When to Stop Oncological Treatment in Palliative Patients - an Increasing Challenge in Times of Immunooncology].
One third of oncological treatment costs per patient is allocated to the last phase of life. In the era of molecular oncology and immuno-oncology, patients benefit from new treatment options inducing durable and long-lasting responses. However, it becomes more difficult to estimate the prognosis of oncology patients. ⋯ Early integration of palliative medicine and advance care planning focus on the patient's medical perspective. Clinical trials investigating the integration of oncology and palliative care point to health gains: improved survival and symptom control, less anxiety and depression, reduced use of futile chemotherapy at the end of life, improved family satisfaction and quality of life, and improved use of health-care resources. Changes at the system level are necessary for implementation of advance care planning to improve the quality of the end of life of oncology patients.
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Patients with palliative diseases often suffer from a variety of onerous symptoms with marked impairment in quality of life. The treatment is often difficult. One reason is that patients usually have several problems at the same time. ⋯ Sometimes medication has to be used in an off-label way, and sometimes one must just hold a hand and be there for the patient or their relatives. The most important principle in working with palliative care patients is to maintain or restore quality of life. Our therapy should always be adapted to the needs of the patient and the most important goal is to preserve our patients' autonomy.
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Electrochemotherapy (ECT) is a symptom control method for inoperable or exulcerating cutaneous metastases or skin cancer. With the help of electroporation, an enhancement of the efficacy of the administered chemotherapeutic agent, bleomycin or cisplatin, is achieved, which leads to a local reduction of the metastases and thereby has a low impact on the systemic health. ECT can be performed under local, regional or general anaesthesia, whereby the form of anaesthesia depends on the number and extent of the metastases as well as the affected body site. ⋯ To prevent lung damage from bleomycin, the patient has to be ventilated with a low FiO2 (< 0.3), or preferably with room air. To avoid drug interactions and postoperative pain, general anaesthesia is performed as TIVA in deep relaxation. The anaesthesia team should be aware of the necessary precautions when applying chemotherapeutic agents and should recognize contraindications to performing anaesthesia in ECT in advance.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2020
[Palliative Care in Intensive Care Units].
Palliative care is becoming increasingly important in intensive care units. The main goal of palliative treatment is to improve quality of life in patients with critical and life-threatening conditions when curative therapies can no longer be achieved. Treatment is not limited to end-of-life care, but also includes relief of distressing symptoms such as pain, nausea, vomiting, dyspnea, delirium or anxiety, as well as communication with patients and their families. ⋯ The "integrative model" presumes that all patients with critical illness may benefit from palliative care principles and interventions practiced by the ICU team. The "consultative model" involves palliative care consultants in the care of ICU patients with palliative care need that may be identified using trigger criteria. This article gives an overview on different aspects of palliative care in intensive care units and provides practical advice for the implementation of palliative care in the ICU.