Description
Palliative care is a specialized form of medical care focused on improving the quality of life for people with serious illnesses, including cancer. It can be provided at any stage of cancer, and it can be offered alongside curative treatment. For cancer patients, it often includes pain management, symptom control, and support for emotional and psychological needs. It improves the overall quality of life for cancer patients, and may even extend their life expectancy. Palliative care is an important component of comprehensive cancer care, and should be considered as an essential part of a patient's treatment plan.
Summary Listen
- Oxygen therapy is the administration of supplemental oxygen in addition to room air. Hypoxemia is a decrease in the partial pressure of oxygen (PaO2 < 60 mmHg), while hypoxia is insufficient oxygen supply to meet oxygen demand at the alveolar or tissue level. Long-term oxygen therapy involves at least 15 hours of daily oxygen use for chronically hypoxemic patients.
- Oxygen transport involves three steps: oxygen uptake (external respiration), oxygen transport in blood, and diffusion to cells (tissue oxygenation). Arterial hypoxemia can result from decreased oxygen intake, alveolar hypoventilation, ventilation-perfusion mismatch, diffusion defects (e.g., ILD), or shunting (e.g., pneumonia).
- Bedside assessment of hypoxemia includes clinical examination, chest x-ray, and arterial blood gas (ABG) analysis. ABG assessment focuses on PaCO2 and the A-a gradient. The A-a gradient helps differentiate causes of hypoxemia, such as hypoventilation, ventilation-perfusion mismatch, diffusion defects, and shunts.
- Oxygen delivery devices are categorized as low-flow (variable FiO2) or high-flow (fixed FiO2). Low-flow devices include nasal cannula, simple face masks, and reservoir bags. High-flow devices include blending systems, Venturi masks, and high-flow nasal cannula (HFNC). The choice of device depends on the degree of hypoxemia and desired FiO2.
- Oxygen prescription should specify the delivery device, flow rate, target saturation, duration, and monitoring instructions. Monitoring methods include pulse oximetry and ABG analysis. The oxygen dissociation curve highlights the importance of maintaining saturation above 90% to avoid a steep drop in PaO2.
- Complications of oxygen therapy include absorption atelectasis, hypercapnic respiratory failure, and ARDS. Hypercapnic respiratory failure can occur in COPD patients due to loss of hypoxic pulmonary vasoconstriction. The goal is to use the lowest possible FiO2 to prevent oxygen toxicity. In end-of-life care, the goal is to maintain patient comfort, with a target saturation of 92-94%.
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