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Palliative Medicine & Care: Open Access
At the end of life, many patients suffer from a syndrome that simulates classic small bowel obstruction. The traditional approach to intestinal obstruction is relief of pressure in the gastrointestinal tract using mechanical methods such as naso-gastric tube insertion and suctioning. This relieves the distension of the hollow organs and thus the nausea.. Pharmacologic methods are also used in the care of these patients, however, there is debate as to which agents to use and when to use them. The Medical Decompression protocol is a non-invasive pharmacologic approach to this problem. It brings with it ease and economy of delivery, the ability to administer it in intravenous as well as oral form, and is a multi-agent protocol of tried and true drugs used at the end of life: 1/2 Metoclopramide, Dexamethasone, Diphenhydramine, and Pantoprazole Prior to initiating this intervention, patients and their families are educated and are aware that this intervention is most likely a temporary measure aimed at symptom relief, as well as an attempt to improve quality of life. Our sample contained 42 males and 62 females, with an average age of about 70 years. About 51% of participants received MD (n = 53). Results indicated that there was a statistically significant difference between the two groups related to days to progress diet. We propose that a pharmacologic method such as MD is strongly considered as first line treatments for the functional intestinal obstruction syndrome and indeed be considered as adjuncts to allow the removal of invasive mechanical interventions in the end of life patient.
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Calves, Pedro H.; Saraceno, Cindy Kaye; Eckardt Erlanger, Ann C. PsyD, ABPP; and Eckardt, Patricia A., "The Effect Of A Medical Decompression Protocol On The Use Of Antiemetics, Nasogastric Tube Usage And Diet Advance In Late Stage Cancer Patients With Functional Intestinal Obstruction" (2017). Faculty Works: Psychology. 2.