| Review question 6b | For people in the last days of life, which pharmacological agents are most effective in providing relief for troublesome respiratory secretions and what degree of sedation do they cause? |
| Objectives | To identify the most effective pharmacological treatment for respiratory secretions in the last days of life. |
| Population | Adults in the last days of life
Exclusions:
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| Intervention |
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| Comparison(s( |
Any of the above Placebo Usual care
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| Outcomes | CRITICAL
Quality of life (either patient-rated, clinician-rated, carer-rated) Sedation (either patient-rated, clinician-rated, carer-rated) Subjective or objective improvement in respiratory secretions (patient-rated, clinician-rated, carer-rated).
IMPORTANT
Frequency of adverse events - for example Paradoxical agitation, Failure to expectorate, Dry mouth Subjective ratings from informal carers' on distress relating to noisy breathing/respiratory secretions. Subjective ratings from patients' on distress related to noisy breathing/respiratory secretions.
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| Subgroups | Drug class
Routes of administration
Enteral (includes oral and enteral tubes) Intramuscular Intravenous Subcutaneous Transdermal Transmucosal (includes sublingual, buccal, nasal).
Delivery system
‘Melt’ tablet Bolus SC injection or continuous SC delivery by syringe driver Continuous IV delivery by pump or Intermittent IV delivery by PCA IM injection Nasogastric tube PEG tube Skin patch Sublingual, buccal, dissolving tablet Tablet, liquid for enteral access.
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| Study design |
Exclusions:
Animal studies |
| Population size and directness | No restrictions. |
| Setting | All settings. |
| Search Strategy | The databases to be searched are Medline, Embase, The Cochrane Library, CINAHL, PsychINFO
Studies will be restricted to English language only. |
| Review Strategy | Appraisal of methodological quality:
Synthesis of data:
A stepwise approach is suggested:
If sufficient randomised evidence is identified, observational studies will not be added If observational studies are considered then studies accounting for confounding factors (multivariable analysis or matching) will be considered next.
Only if insufficient randomised or multivariable data are identified will other non-randomised comparative evidence be considered
Data on the following groups will be presented separately, if the evidence allows:
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