For many patients the fear of dying in a state of marked breathlessness with acute anxiety / panic is their biggest, if unspoken, fear.
For many patients advancing disease is often associated with reduced awareness. However it is usually prudent to discuss the option of sedation should increasing distress become an issue. Most patients are comforted by the knowledge that medication is helpful and available if required.
Patients who are persistently breathless and distressed may benefit from a continuous infusion of opioid and/or midazolam – in practice try to ascertain the required dose(s) by observing and titrating according to usage of opioid or midazolam over the previous 24–48 hours.
For some patients in the dying phase it may be more practical to commence an infusion of morphine/diamorphine or midazolam at an earlier stage alongside the provision of additional PRN medication.
See also the chapter Palliation of Breathlessness.
This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.