Palliative Care on Patients With Paraquat Poisoning: Analysis of 90 Cases From 2005–2016

Abstract

Summary: Background: Paraquat poisoning has high mortality rate. Hospice services have been provided by National Health Insurance program in Taiwan since 2000, and were expanded to noncancer illnesses in September 2009. The palliative care strategy and the impact of this expanded palliative care policy on patients with paraquat poisoning remain unclear. Methods: The study included 90 in-patients with paraquat poisoning, hospitalized between January 2005 and April 2016. We analyzed these patients by two factors, survivors vs. non-survivors and patients admitted between 2005 and 2010 vs. between 2011 and 2016, to compare the differences in life-sustaining treatment orders, symptom management, and use of non-beneficial life-sustaining treatments. Results: The mortality rate was 75.6% and patients progressed rapidly to death (mean time: 74.69 h). 91.2% of non-survivors had a do-not-resuscitate order. Within the 24 h before death, non-survivors in the 2011–2016 group had significantly less treatment with vasopressors (p < 0.001) and mechanical ventilation (p = 0.004), and cardiopulmonary resuscitation (p = 0.008) than those in the 2005–2010 group. There was no difference in use of antibiotics, immunosuppressive agents, hemoperfusion, and opioids or benzodiazepines. Conclusion: Patients with paraquat poisoning are suitable candidates to have palliative care, owing to the extremely high mortality rate and rapid disease progression. The expanded palliative care policy had a positive impact on terminal paraquat poisoning patients; it decreased non-beneficial life-sustaining treatments in the end-stage of disease. Nevertheless, there is still much room for improvement in our management of paraquat poisoning by reducing non-beneficial life-sustaining treatments and reinforcing palliative treatments. Keywords: paraquat, palliative care, do-not-resuscitate, respiratory failure