Effect of hydromorphone on ventilation in palliative care patients with dyspnea.

Goals: This study assessed the effect of hydromorphone treatment on ventilation and the intensity of dyspnea in palliative care patients. The assessments measured changes in peripheral oxygen saturation (SaO(2)), transcutaneous arterial pressure of carbon dioxide (tcpaCO(2)), respiratory rate (f), and pulse frequency (PF) during the titration phase with hydromorphone for symptomatic therapy of dyspnea. The aims of the study were to verify the efficacy of hydromorphone for the management of dyspnea and assess its effect on ventilation.

Materials And Methods: Fourteen patients admitted to our palliative care unit were included in this prospective, nonrandomized trial. At admission, all patients suffered from dyspnea. TcpaCO(2), SaO(2), and PF were measured transcutaneously by means of a SenTec Digital Monitor (SenTec AG, Switzerland).

Main Results: As early as 30 min after the first hydromorphone application, mean respiratory rate decreased from 38.8 +/- 4.9 breaths/min (range 30.0-45.0 breaths/min) to 34.6 +/- 4.2 breaths/min (29.0-41.0 breaths/min); after 120 min to 29.0 +/- 3.1 breaths/min (range 24.0-33.0 breaths/min) (p = 0.001). The other monitored respiratory parameter, however, showed no significant changes. A significant improvement was shown in the intensity of dyspnea [numeric rating scale 0-10: 5.2 +/- 1.5 (4-8)/6.4 +/- 2.1 (4-10) vs 1.1 +/- 0.9 (0-3)/2.3 +/- 1.3 (1-5); p = 0.001].

Conclusions: Neither was there a significant decrease in SaO(2) nor a significant increase in tcpaCO(2) after the initial hydromorphone application, i.e., there was no hydromorphone-induced respiratory depression. The first hydromorphone application, however, resulted in a significant decrease in the intensity of dyspnea and respiratory rate.