Principles of emergency management of severe acute breathlessness in palliative care
Severe acute breathlessness (a breathlessness crisis) is a medical emergency. Immediately start symptomatic management for severe acute breathlessness in patients with palliative care needs, including:
- following the patient’s breathlessness action plan, if present
- encouraging the patient to sit up and adopt a comfortable posture
- environmental measures such as increasing cool air movement around the patient, opening doors and windows, and using bedside fans or cool face washers
- oxygen therapy for hypoxaemia
- opioid therapy
- benzodiazepine therapy for anxiety and distress associated with breathlessness that does not respond to nonpharmacological and opioid therapy
- considering noninvasive ventilation for decompensated hypercapnic respiratory failure.
Management is often undertaken simultaneously while identifying and managing reversible causes (see Assessing breathlessness in palliative care). Consider the potential benefits and burdens of investigations and treatment, and the patient’s prognosis, preferences and goals of care. See also Emergencies in palliative care for principles of managing medical emergencies in palliative care.
Patients with severe acute breathlessness often have chronic breathlessness. After an episode of severe acute breathlessness has passed, assess whether the patient has chronic breathlessness and ensure a comprehensive management plan is provided for the future—see Principles of managing chronic breathlessness in palliative care.
For management of breathlessness in the last days of life, see Breathlessness causing distress in the last days of life.
If death appears imminent, and the patient is distressed by their breathlessness, see Catastrophic terminal events in palliative care for management.