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A retrospective analysis of dexamethasone use on a Canadian palliative care unit

机译:地塞米松在加拿大姑息治疗病房使用的回顾性分析

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Corticosteroids are widely used in palliative care for a variety of reasons. Although benefit generally outweighs the risk in the palliative care population, side effects are common and necessitate judicious use. In order to qualify and quantify our corticosteroid use, we conducted a retrospective chart review, and subsequent statistical analysis, of 65 patients admitted to a Tertiary Palliative Care Unit at St Boniface General Hospital in Winnipeg, Manitoba, Canada. Of our 65 patients, 42 (65%) were on corticosteroids at some point during their admission, and 25 were on corticosteroids at the time they were admitted. Many of the patients on steroids underwent a taper once their course was complete but only 4% completed the taper prior to their deaths. There was a large amount of inter- and intra-physician variability for dosing, even for the same indication. Dosing had a biphasic distribution with one peak around a total daily dose of 4-8 mg of dexamethasone and another peak around 16 mg of dexamethasone. Side effects possibly attributable to corticosteroids, such as thrush, psychiatric complications, skin breakdown, and other forms of infections were common, occurring 31 times in 20 different people. This study compares the results of our retrospective review with previously published guidelines and discusses possible explanations for observed differences.
机译:出于多种原因,皮质类固醇广泛用于姑息治疗。尽管在姑息治疗人群中获益通常超过风险,但副作用是常见的,因此必须谨慎使用。为了对我们使用皮质类固醇激素进行鉴定和量化,我们对加拿大曼尼托巴省温尼伯市圣博尼法斯综合医院第三级姑息治疗病房收治的65例患者进行了回顾性图表审查和随后的统计分析。在我们的65位患者中,有42位(65%)在入院时使用皮质类固醇,入院时有25位在使用皮质类固醇。病程结束后,许多接受类固醇治疗的患者都会接受锥度治疗,但只有4%的患者在死亡前完成了锥度治疗。即使在相同的适应症下,医生之间和医生内部的剂量差异也很大。给药具有双相分布,在每天总剂量4-8 mg地塞米松附近有一个峰,在约16 mg地塞米松附近又有一个峰。鹅口疮,精神病并发症,皮肤破裂和其他形式的感染等可能归因于皮质类固醇的副作用很常见,在20个不同的人群中发生了31次。这项研究将我们的回顾性研究结果与以前发布的指南进行了比较,并讨论了观察到的差异的可能解释。

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