Comment soulager un patient dyspnéique en fin de vie ?

Abstract

Dyspnea is a very common symptom that particularly worries the patient and his relatives. In terminally ill patients, there is no correlation between dyspnea and hypoxaemia. Although a specific cause may require an appropriate treatment, most of the time the treatment is symptomatic. This approach is based on oral or parenteral administration of opioids but with a narrower safety margin than in chronic pain patients. The use of an anxiolytic is indicated in stressful circumstances or when opioids fail. Oxygen administration should be discussed on an individual basis and not conditioned to the achievement of full arterial blood saturation. The airstream effect may improve patient's condition as well as oxygen itself. Facial masks impair communication with the relatives and are poorly tolerated over a long period of time. Accumulation of respiratory tract secretions occurs during the last days of life in half of the patients, due to excessive production, impaired swallowing, pulmonary edema and ineffective coughing.