ABSTRACT
Restlessness can make dying unnecessarily difficult, not only for the patient himself, but also for his family and the physician in charge. Four cancer patients, three men aged 69, 80 and 66 and a woman aged 88, displayed severe terminal restlessness, caused by nicotine abstinence, hypoglycaemia, constipation and urinary retention, respectively. Suitable interventions helped the patients to die in peace and dignity. Facing restless terminal patients the physician should think of withdrawal symptoms, metabolic derangements, full bladder and (or) rectum and intoxication by drugs, frequently morphine. Interventions directed at those problems may bring surprising results.
Subject(s)
Psychomotor Agitation/therapy , Terminal Care , Aged , Aged, 80 and over , Constipation/complications , Constipation/therapy , Female , Humans , Hypoglycemia/complications , Hypoglycemia/therapy , Male , Nicotine/adverse effects , Psychomotor Agitation/etiology , Substance Withdrawal Syndrome/complications , Substance Withdrawal Syndrome/therapy , Urinary Retention/complications , Urinary Retention/therapyABSTRACT
In a retrospective review we analysed alveolar-arterial oxygen difference (AaDO2) as an entry criterion for extracorporeal membrane oxygenation (ECMO) in neonates with several forms of acute respiratory insufficiency. Although for meconium aspiration syndrome, respiratory distress syndrome, sepsis, and idiopathic pulmonary hypertension of the newborn we found values in accordance with the literature, patients with congenital diaphragmatic hernia (CDH) met 80% mortality criteria with significant lower AaDO2 values. Several patients died before ever reaching usual entry criteria for ECMO, because serious lung deterioration makes AaDO2 values unreliable. Awaiting classical ECMO entry criteria for patients with CDH may at least partially explain the lower survival rate for ECMO in CDH.
