{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T13:53:12Z","timestamp":1777384392800,"version":"3.51.4"},"reference-count":26,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T00:00:00Z","timestamp":1678665600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Hosp Palliat Care"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We describe two complex cases in the setting of COVID-19 at the End of Life, to enhance learning for all patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>Maintenance of sustained comfort in two cases required multiple drugs, specifically selected for symptoms that necessitated three separate pumps delivering continuous 24-hour subcutaneous infusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Management<\/jats:title>\n                    <jats:p>Management of sustained comfort included opioid, midazolam, anti-secretory, diclofenac for intractable temperature, phenobarbital for extreme agitation, in one, where seizure activity was present, while insomnia, was a prominent feature of another. Management of Akatasia was also required.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Outcome<\/jats:title>\n                    <jats:p>Attention to each individual patient\u2019s rapidly evolving symptoms, during the dying phase, with a thorough differential diagnosis, wa s vitally important in the context of a \u2018Good Death\u2019. This was achieved in both cases, reflected by evidence at the bedside of comfort and a minimum need for \u2018as required\u2019 drugs in the last days of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>COVID-19 being a new illness, we need to prospectively study the symptom burden\/clustering at End of Life and learn from management of this new disease for other illnesses also. Further research is required to develop protocols on; when does Midazolam dose reach tolerance and when should an alternative drug such as phenobarbital for sustained Gamma-Aminobutyric Acid effects be initiated; examine the optimal approach to sustained temperature control; be cognisant of extrapyramidal side effects of drugs used at End of Life and consider looking at a lack of need for \u2018as required\u2019 drugs in the last days of life as an outcome measure of sustained comfort.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10499091231164135","type":"journal-article","created":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T05:52:50Z","timestamp":1678686770000},"page":"113-118","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Extreme Symptom Burden for Patients With COVID-19 at the End of Life; Extrapolation of Knowledge Gained to Achieve Sustained Comfort and Dignity for all Patients in Their Last Days of Life\n                    <sup>1<\/sup>"],"prefix":"10.1177","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3152-040X","authenticated-orcid":false,"given":"Dympna","family":"Waldron","sequence":"first","affiliation":[{"name":"Department of Palliative Medicine, Galway University Hospital, Saolta Hospitals Group, Ireland"},{"name":"Department of Medicine, University of Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine Eileen","family":"Mc Carthy","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine, Galway University Hospital, Saolta Hospitals Group, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Murphy","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine, Galway University Hospital, Saolta Hospitals Group, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janusz","family":"Krawczyk","sequence":"additional","affiliation":[{"name":"Department of Haematology, Galway University Hospital, Saolta Hospitals Group, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine, University Hospital Kerry, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fiona","family":"Walsh","sequence":"additional","affiliation":[{"name":"Department of Medicine, Sligo University Hospital, Sligo, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eileen","family":"Mannion","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine, Galway University Hospital, Saolta Hospitals Group, Ireland"},{"name":"Department of Medicine, University of Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2023,3,13]]},"reference":[{"key":"bibr1-10499091231164135","doi-asserted-by":"publisher","DOI":"10.7573\/dic.2020-5-1"},{"key":"bibr2-10499091231164135","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2008597"},{"key":"bibr3-10499091231164135","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(20)30203-0"},{"key":"bibr4-10499091231164135","doi-asserted-by":"publisher","DOI":"10.1016\/j.psym.2020.05.013"},{"key":"bibr5-10499091231164135","doi-asserted-by":"publisher","DOI":"10.1017\/S1041610220000836"},{"key":"bibr6-10499091231164135","doi-asserted-by":"publisher","DOI":"10.1177\/0269216320935361"},{"key":"bibr7-10499091231164135","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2021436"},{"key":"bibr8-10499091231164135","volume-title":"StatPearls. 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