(20) Evaluating The Use Of Aerosolized Opioids To Improve Dyspnea In Pediatric Patients At The End Of Life.

Title: Evaluating The Use Of Aerosolized Opioids To Improve Dyspnea In Pediatric Patients At The End Of Life.

Abstract : Basis of Inquiry: More than 50% of patients with advanced diseases experience dyspnea at end of life (EOL) (Alfolabi et al., 2017). Managing dyspnea in the terminally ill oncology patient is challenging. The use of systemic opioids is thought to relieve dyspnea by suppressing spontaneous respiratory drive, modulating cortical activity, and dampening brainstem chemoreceptors’ ability to detect hypoxia and hypercapnia (Alfolabi et al., 2017). Administering opioids through nebulization has been considered to avoid adverse effects of systemic opioids.

Purpose/

Objectives: For pediatric patients receiving palliative care, does the use of aerosolized morphine treatment compared to IV or enteral route improve dyspnea?

Methods: An electronic literature review was conducted using CINAHL and PubMed, with inclusion criteria: peer-reviewed journal, pediatric patients, published in the last twenty years. Search terms included: pediatric, morphine, opioid, narcotic, aerosol, and dyspnea. This search yielded 19 articles, with 16 included in the final appraisal. Palliative Care Subject Matter Experts (SMEs) were surveyed to understand efficacy and benefit, if any, of aerosolized morphine for dyspnea. A large majority of SMEs felt that there was not enough present data to use this method of dyspnea management. Stakeholders were surveyed to understand institutional practice by utilizing the open forum discussion board via the APHON website. There response on the discussion board states that aerosolized morphine was used but was unable to be reached for supporting evidence.

Findings: The current available evidence indicates little support of the use of inhaled opioids to treat dyspnea in pediatric patients. This search revealed a limited amount of good quality evidence. A well-designed multicenter research study is warranted to determine best practice. Documented data, in addition to palliative care SMEs and stakeholders confirm that currently, there is insufficient data and research to use aerosolized opioids to treat end of life dyspnea in pediatric patients.