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Impending death : systematic review of the symptoms and signs in the last days of life
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Resumo(s)
A maioria das mortes ocorre após um período longo de doença crónica. Desta forma, é expectável que estes doentes experienciem um período ímpar na sua vida, frequentemente previsível e gradual, composto por verdadeiras alterações, conhecido por morte iminente. A capacidade de identificar os sinais e sintomas que caracterizam esta fase pode ajudar não só a entender melhor a fisiopatologia do processo de morte, mas também ajudar os clínicos a tomar as melhores decisões, de forma a garantir a dignidade e a qualidade de vida que estes doentes necessitam, facilitar a comunicação com as suas famílias e também permitir uma melhor gestão de recursos de saúde. O objetivo deste trabalho foi estudar os sinais e sintomas que ocorrem nos últimos dias de vida num doente crónico. Uma pesquisa de revisão realizada em diferentes bases de dados médicas (PubMed, Cochrane Library e European Journal of Palliative Care) revelou 46 sinais e sintomas que caracterizam o doente perto da morte e as suas prevalências relativamente às últimas 24 horas, 2 dias, 3 dias, 7 dias e 14 dias de vida. Em geral, os resultados obtidos encontram-se em conformidade com estudos anteriores. Contudo, tendo em conta que a definição temporal de morte iminente ainda não se encontra bem estabelecida, é difícil conseguir chegar a uma conclusão definitiva. São necessários mais estudos para ajudar os clínicos a reconhecer o doente na sua fase final de vida.
Most deaths occur after a period of chronic and prolonged illness. Therefore, it is expected that these patients will experience a final period of life, usually predictable and gradual, composed of real physiological changes, known as impending death. Identifying the signs and symptoms of imminent death can not only help to understand the physiopathology of death but also help clinicians to make the best decisions in order to guarantee the dignity and quality of life of these patients and support for their families, as well as to ensure a better management of hospital resources. The objective of this study was to identify the signs and symptoms that occur in the last days of life of a patient with chronic disease. A systematic search of medical databases (PubMed, Cochrane Library, and European Journal of Palliative Care) revealed 46 signs and symptoms that characterized a patient nearing death and their prevalence specifically on the last 24 hours, 2 days, 3 days, 7 days, and 14 days of life. The findings of the most common signs and symptoms are consistent with previous studies. However, since the temporal definition of death is still not established, it is difficult to reach any definitive conclusions. There is a need for future high-quality research to help clinicians to recognize patient’s terminal phase.
Most deaths occur after a period of chronic and prolonged illness. Therefore, it is expected that these patients will experience a final period of life, usually predictable and gradual, composed of real physiological changes, known as impending death. Identifying the signs and symptoms of imminent death can not only help to understand the physiopathology of death but also help clinicians to make the best decisions in order to guarantee the dignity and quality of life of these patients and support for their families, as well as to ensure a better management of hospital resources. The objective of this study was to identify the signs and symptoms that occur in the last days of life of a patient with chronic disease. A systematic search of medical databases (PubMed, Cochrane Library, and European Journal of Palliative Care) revealed 46 signs and symptoms that characterized a patient nearing death and their prevalence specifically on the last 24 hours, 2 days, 3 days, 7 days, and 14 days of life. The findings of the most common signs and symptoms are consistent with previous studies. However, since the temporal definition of death is still not established, it is difficult to reach any definitive conclusions. There is a need for future high-quality research to help clinicians to recognize patient’s terminal phase.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Palavras-chave
Atitudes em relação à morte Avaliação de sintomas Doente terminal Cuidados paliativos Sinais e sintomas Bioética