From research to reality: A review of three clinical problems in the last days of life.

Abstract

All of us will one day die. For most of us, death will be anticipated, usually following a period of ill health. The opportunity to anticipate and manage clinical conditions associated with the agonal process is an essential part of advance care planning. Guidelines exist for the palliation of most symptomatic events at the end of life, although many recommendations are based on low-quality evidence or consensus. Furthermore, when potentially practice-changing data emerge, there is an inevitable lag time before clinical practice changes. In this paper, we shall discuss the management of three challenging scenarios faced by teams looking after patients at the end of life: delirium, terminal haemorrhage and noisy upper airway secretions. We aim to critically evaluate the utility of current evidence, pharmacological and non-pharmacological, and how it translates into clinical practice.