Palliative approach in acute neurological events: a five-year study

Monteiro, N.; Cipriano, P.; Freire, E.

Publication

Palliative approach in acute neurological events: a five-year study

2018-09Journal article

dc.contributor.author	Monteiro, N.
dc.contributor.author	Cipriano, P.
dc.contributor.author	Freire, E.
dc.date.accessioned	2020-03-17T18:29:31Z
dc.date.available	2020-03-17T18:29:31Z
dc.date.issued	2018-09
dc.description.abstract	Introduction: Acute neurological illness often results in severe disability. Five-year life expectancy is around 40%; half the survivors become completely dependent on outside help. Objective: Evaluate the symptoms of patients admitted to a Hospital ward with a diagnosis of stroke, subarachnoid hemorrhage or subdural hematoma, and analyze the role of an In-Hospital Palliative Care Support Team. Material and methods: Retrospective, observational study with a sample consisting of all patients admitted with acute neurological illness and with a guidance request made to the In-Hospital Palliative Care Support Team of a tertiary Hospital, over 5 years (2012-2016). Results: A total of 66 patients were evaluated, with an age median of 83 years old. Amongst them, there were 41 ischaemic strokes, 12 intracranial bleedings, 12 subdural hematomas, and 5 subarachnoid hemorrhages. The median of delay between admission and guidance request was 14 days. On the first evaluation by the team, the GCS score median was 6/15 and the Palliative Performance Scale (PPS) median 10%. Dysphagia (96.8%) and bronchorrhea (48.4%) were the most prevalent symptoms. A total of 56 patients had a feeding tube (84.8%), 33 had vital sign monitoring (50.0%), 24 were hypocoagulated (36.3%), 25 lacked opioid or anti-muscarinic therapy for symptom control (37,9%); 6 patients retained orotracheal intubation, which was removed. In-hospital mortality was 72.7% (n=48). Discussion and conclusion: Patients were severely debilitated, in many cases futile interventions persisted, yet several were under-medicated for symptom control. The delay between admission and collaboration request was high. Due to the high morbidity associated with acute neurological illness, palliative care should always be timely provided.	pt_PT
dc.description.abstract	INTRODUÇÃO: Eventos neurológicos agudos resultam frequentemente em incapacidade grave que impede o doente de participar ativamente nas decisões do seu próprio tratamento. A sobrevida a cinco anos ronda os 40%; metade dos sobreviventes fica dependente de terceiros. Objetivo: Avaliar a sintomatologia de doentes internados com acidente vascular cerebral (AVC), hemorragia subarcnoideia (HSA) ou subdural (HSD) e analisar a intervenção de uma Equipe Intra-Hospitalar de Suporte em Cuidados Paliativos (EIHSCP). MATERIAL E MÉTODOS: Estudo retrospetivo observacional dos doentes com diagnóstico principal de evento neurológico agudo com pedido de colaboração à EIHSCP, num hospital terciário, durante cinco anos (2012-2016). RESULTADOS: Avaliados 66 doentes, com média de idade de 83 anos. Destacam-se 41 AVC isquêmicos, 12 hemorrágicos, 12 HSD e 5 HSA. A média da demora entre internamento e pedido de colaboração à EIHSCP foi de 14 dias. Na primeira observação, a média na escala de coma de Glasgow foi de 6/15 e na Palliative Performance Scale (PPS) foi de 10%. Disfagia (96,8%) e broncorreia (48,4%) foram os sintomas mais frequentes. A maioria dos doentes (56/66) mantinha sonda nasogástrica (84,8%); 33 encontravam-se em monitorização cardiorrespiratória (50,0%); 24 estavam sob hipocoagulação (36,3%); 25 necessitavam de opioide e antimuscarínico que não estavam prescritos (37,9%); seis tinham tubo orotraqueal, que foi retirado. A mortalidade intra-hospitalar foi de 72,7% (n=48). DISCUSSÃO E CONCLUSÃO: Destaca-se o estado debilitado dos doentes; em muitos casos, intervenções fúteis persistiam, mas várias foram submedicadas para o controle dos sintomas. Verificou-se um tempo de espera elevado até o pedido de colaboração. Pela elevada morbilidade associada a esses eventos, cuidados paliativos diferenciados deveriam ser oferecidos no tempo adequado	pt_PT
dc.description.version	info:eu-repo/semantics/publishedVersion	pt_PT
dc.identifier.citation	Monteiro NF, Cipriano P, Freire E. Palliative approach in acute neurological events: a five-year study. Rev Assoc Med Bras (1992). 2018;64(9):833–836.	pt_PT
dc.identifier.doi	10.1590/1806-9282.64.09.832	pt_PT
dc.identifier.issn	0104-4230
dc.identifier.issn	1806-9282
dc.identifier.uri	http://hdl.handle.net/10400.16/2322
dc.language.iso	eng	pt_PT
dc.peerreviewed	yes	pt_PT
dc.publisher	Associação Médica Brasileira	pt_PT
dc.relation.publisherversion	http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302018000900833&lng=en&nrm=iso&tlng=en	pt_PT
dc.rights.uri	http://creativecommons.org/licenses/by-nc/4.0/	pt_PT
dc.subject	Cerebrovascular disorders	pt_PT
dc.subject	Stroke	pt_PT
dc.subject	Palliative care	pt_PT
dc.title	Palliative approach in acute neurological events: a five-year study	pt_PT
dc.type	journal article
dspace.entity.type	Publication
oaire.citation.conferencePlace	Brazil	pt_PT
oaire.citation.endPage	836	pt_PT
oaire.citation.issue	9	pt_PT
oaire.citation.startPage	833	pt_PT
oaire.citation.title	Revista da Associacao Medica Brasileira (1992)	pt_PT
oaire.citation.volume	64	pt_PT
rcaap.rights	openAccess	pt_PT
rcaap.type	article	pt_PT