Important to identify COVID-19 patients for supportive care instead of ICU: expert

By Emma Wilkinson

16 Apr 2020

Identifying patients with COVID-19 who may not be suitable for admission to intensive care is vital in order to provide a package of supportive care that involves symptom control and psychological support, a group of specialists in palliative care have said.

Providing good supportive care does not make someone’s chances of survival worse but can improve the quality and in some cases length of life, said Dr Sabrina Bajwah, Honorary Consultant in Palliative Care at King’s Health Partners and Palliative Care Lead for the NIHR South London Clinical Research Network.

Writing in the European Respiratory Journal, Dr Bajwah and colleagues said there is a “moral obligation” to provide good symptom control to prevent suffering in those who would not benefit from escalation to intensive care, such as those with frailty or multiple co-morbidities.

But families of patients with COVID-19 will also require particular support in the absence of being able to visit a loved one, they add.

Speaking with the limbic, Dr Bajwah said more guidance was needed for physicians on how best to support people who may be very ill or dying from or with COVID-19.

“This is a new disease, there was little guidance, and most guidance that existed missed the supportive needs of patients and families.”

The advice covers the management of symptoms such as use of opioids and other pharmacological intervention in the management of breathlessness, cough, and delirium in those for whom active intensive care treatment may not be appropriate.

In addition, it stresses the importance of managing the anxiety that “is likely to be present to some degree in all patients with COVID-19”.

Severely ill patients may be particularly distressed over the knowledge that their situation may rapidly worsen and that they may die compounded by not being able to see their families as well as receiving care from health professionals in personal protective equipment, the authors point out.

“It is important that whilst we are treating patients as actively as is appropriate, we relieve suffering,” says Dr Bajwah.

“Supportive care involves not only managing the symptom control needs of patient, such as breathlessness, but it also addresses psychological distress, spiritual care and information needs.”

She said research on lung diseases before the pandemic shows that supportive and palliative care, relieving symptoms, doesn’t make someone’s chances of survival worse.

“There is evidence now that good palliative care can improve both the quality and, sometimes, the length, of life.”

While the guidance focuses on those admitted to hospital, many aspects are transferable to other settings, Dr Bajwah added.

The team have also produced downloadable  factsheets for those admitted to hospital with COVID-19 and their families which have been translated into multiple languages

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