Morphine and oxygen use in terminally ill patients with dyspnea in Brazil

Abstract

<b>Background:</b> Dyspnea is a disabling symptom for many patients facing life-limiting diseases, but unrecognized and undertreated, especially at the end of life. Morphine and oxygen therapy are frequently used agents for refractory dyspnea. <b>Aims:</b> To evaluate morphine use and oxygen therapy in patients at the end of life with and without dyspnea in a public hospital in Brazil. <b>Methods:</b> Retrospective cross-sectional study that included all adult patients selected for end-of-life and palliative care who died from July to December 2018 at Hospital Regional da Asa Norte, Brasília, Distrito Federal, Brazil. Criteria for end-of-life were defined according to the Prognostic Indicator Guidance (PIG-GSF). Deaths that occurred in ICU and operating rooms were excluded. <b>Results:</b> Sixty-seven patients selected for palliative care were included, corresponding to 33,5% hospital adult deaths. Mean age was 74.5 ± 15.2 years, 49.3% male, and neoplasia was the most common primary diagnosis (52.2%). Morphine was used in 32 patients (47.8%) and oxygen therapy in 59 patients (88.1%).&nbsp;Fifty patients reported dyspnea in the last 24 hours of life (74.6%). There was no difference regarding morphine use in patients with and without dyspnea (52.0% versus 35.3%, p=0.234). Oxygen therapy was more frequent in patients with dyspnea than patients without dyspnea (94.0% versus 70.6%, p&lt;0.050). <b>Conclusions:</b> Morphine use was remarkably low in terminally ill patients, even who reported dyspnea, despite its proven efficacy. Almost all end-of-life dyspnea patients in the general hospital were using oxygen therapy, which may indicate an overestimation of its benefits, underestimating its possible side effects, as well as increasing treatment costs.