The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 6: Pulmonary Symptomssensation of severe dyspnea. Addition of barbiturates often helps to maintain sedation and reducerequired doses of benzodiazepines. Pentobarbital, 100 to 200 mg, can be administeredorally, rectally or parenterally every 3 to 4 hours as needed. Phenobarbital doses of 60 to 120 mgcan be26givenpicasby similar routes every 6 to 12 hours. Doses of drugs need to be adjusted frequentlyand the patient may require extraordinarily high doses of medications (5 to 15 mg/hour ofmidazolam) to maintain comfort as the airway obstruction progresses. However, with carefulattention to the details of dosing, continuous sedation and a peaceful death are possible.Palliative Treatment of Respiratory DepressionWhen serious respiratory depression occurs from excess opiods, patients respond well to carefultitration of naloxone. One ampule of 0.4 mg of naloxone can be diluted in 9 ml of saline and thenone ml (0.04 mg) of this solution can be injected every five minutes until specific symptoms suchas respiratory depression or hypotension are reversed. The goal is to treat the symptoms and notto totally reverse the opioid effect. The doses required to treat life-threatening symptoms usuallyare not disturbing to the recipient and often do not even awaken the patient.CONCLUSION■ Caring for people who are terminally ill is a unique, but rewarding, challenge for health careproviders. As patients face progressive, incurable diseases, we are now able to reassure themthat even their most distressing physical symptoms can be relieved. The less obvious sources ofdistress, such as loss of independence, anxiety about being a burden to family, unfulfilled dreams,the impending separation from loved ones, unresolved conflicts or guilt, and the need to redefinethe goals and purpose of life, also require attention. In addition to effective symptom management,out patients need a safe environment, willing listeners, and a sense of being valued. They alsoneed accurate information about their disease, an understanding of treatment options, ideas ofwhat to expect in the future, and as much control of their lives as possible. When these needs aremet, the majority of terminally ill people experience a peaceful and comfortable death.154U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau