RESUMEN
The purpose of this placebo-controlled, double-blind, randomized study was to assess the effect of nebulized morphine on dyspnoea perceived at rest by patients with advanced disease. Seventeen hospital in-patients with disabling dyspnoea received isotonic saline or morphine via nebulization for 10 min through a mouthpiece, combined with oxygen via nasal prongs. On four consecutive days, they were given one of the four following treatments in random order: saline with 2 L x min(-1) oxygen; 10 mg morphine with 2 L x min(-1) oxygen; 20 mg morphine with 2 L x min(-1) oxygen; and 10 mg morphine without oxygen (prongs fixed, no flow). Dyspnoea was assessed on a bipolar visual analogue scale (VAS) (-100% much more short of breath, +100% much less short of breath), and arterial oxygen saturation (Sa,O2) and respiratory frequency (fR) were recorded at the end of nebulization and 10 min later. In 14 subjects who completed the study, mean VAS ratings 10 min after the end of nebulization ranged +30 to +43%, with no significant difference between the four study days (VAS 20 mg morphine minus VAS saline, 95% confidence interval (95% CI) -6 to +8%). Sa,O2 significantly increased on the 3 days with supplemental oxygen, and remained stable on the zero flow day. Respiratory frequency significantly decreased on the 4 days, with a trend to correlation between VAS rating and parallel change in respiratory frequency (Spearman's rank correlation coefficient (r(s))=0.46; p=0.09). We conclude that the subjects benefited from saline or morphine via a placebo effect and/or a nonspecific effect, and that nebulized morphine had no specific effect on dyspnoea.
Asunto(s)
Analgésicos Opioides/uso terapéutico , Disnea/tratamiento farmacológico , Cardiopatías/tratamiento farmacológico , Enfermedades Pulmonares/tratamiento farmacológico , Morfina/uso terapéutico , Administración Intranasal , Adulto , Anciano , Analgésicos Opioides/administración & dosificación , Análisis de los Gases de la Sangre , Método Doble Ciego , Disnea/diagnóstico , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Morfina/administración & dosificación , Nebulizadores y Vaporizadores , Oxígeno/uso terapéutico , Respiración/fisiología , Cloruro de Sodio/uso terapéuticoRESUMEN
Daily care involving proximity with a malodorous patient in the terminal stage of cancer has often proved difficult for the caregiver. Whatever the cause of the primary cancer, three sources of noxious odor can exist or coexist: necrosis, superinfection, and perspiration and/or discharge. The proposed treatment calls for a twofold approach: internal or general and external or local. The internal treatment consists mainly of antibiotics and often involves the combined use of two drugs. Local treatment is applied "à la carte" according to the origin of the odors. Wounds, vomiting, diarrhea, and so on can be treated with specific treatments which will be discussed further.
