Symptom Control and Survival for People Severely ill With COVID: A Multicentre Cohort Study (CovPall-Symptom).
J Pain Symptom Manage
; 64(4): 377-390, 2022 10.
Article
em En
| MEDLINE
| ID: mdl-35752399
ABSTRACT
CONTEXT Evidence of symptom control outcomes in severe COVID is scant. OBJECTIVES:
To determine changes in symptoms among people severely ill or dying with COVID supported by palliative care, and associations with treatments and survival.METHODS:
Multicentre cohort study of people with COVID across England and Wales supported by palliative care services, during the pandemic in 2020 and 2021. We analysed clinical, demographic and survival data, symptom severity at baseline (referral to palliative care, first COVID assessment) and at three follow-up assessments using the Integrated Palliative care Outcome Scale - COVID version.RESULTS:
We included 572 patients from 25 services, mostly hospital support teams; 496 (87%) were newly referred to palliative care with COVID, 75 (13%) were already supported by palliative care when they contracted COVID. At baseline, patients had a mean of 2.4 co-morbidities, mean age 77 years, a mean of five symptoms, and were often bedfast or semiconscious. The most prevalent symptoms were breathlessness, weakness/lack of energy, drowsiness, anxiety, agitation, confusion/delirium, and pain. Median time in palliative care was 46 hours; 77% of patients died. During palliative care, breathlessness, agitation, anxiety, delirium, cough, fever, pain, sore/dry mouth and nausea improved; drowsiness became worse. Common treatments were low dose morphine and midazolam. Having moderate to severe breathlessness, agitation and multimorbidity were associated with shorter survival.CONCLUSION:
Symptoms of COVID quickly improved during palliative care. Breathlessness, agitation and multimorbidity could be used as triggers for timelier referral, and symptom guidance for wider specialities should build on treatments identified in this study.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Temas:
Geral
Base de dados:
MEDLINE
Assunto principal:
Delírio
/
COVID-19
Tipo de estudo:
Clinical_trials
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Diagnostic_studies
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Etiology_studies
/
Guideline
/
Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Humans
Idioma:
En
Revista:
J Pain Symptom Manage
Assunto da revista:
NEUROLOGIA
/
PSICOFISIOLOGIA
/
TERAPEUTICA
Ano de publicação:
2022
Tipo de documento:
Article