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Palliative Care Dumfries & Galloway

Palliative Care

in Dumfries and Galloway

Staff Area

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Stridor Associated with Advanced Malignancy

Description

Stridor is a sign characterised by a high-pitched breathing sound resulting from turbulent air flow in the upper airways.

Patients will often report distressed breathing and increased distress on lying down.

Consider cause: intrinsic obstructing lesion or extrinsic compression from adjacent structure, for example thyroid.

Management

If stridor is an anticipated part of disease progression (for example head and neck cancer), prepare the
patient and carer and ascertain wishes where possible in advance of severe stridor developing. Ensure wishes and plans for intervention should stridor develop are documented in an Anticipatory Care Plan and electronic Key Information Summary. 

  • If tracheostomy is an option arrange emergency admission for definitive procedure to alleviate obstruction.
  • If tracheostomy is not an option treatment will depend on anticipated prognosis

If the patient is felt to be imminently dying, treat any distress with midazolam titrated up to 10mg IV . If IV route not possible, 10mg may be administered IM if severe distress.

  • Otherwise consider immediate management with corticosteroids and gastroprotection (PPI)
    • Dexamethasone 16mg orally (or IV) immediately
    • and subsequently Dexamethasone 8mg twice daily orally
  • In discussion with senior doctor consider nebulised adrenaline (1:1000) 1mg – 5mg driven on oxygen. Assess response and repeat if necessary.
  • If not for intervention, follow advice for management of breathlessness including the use of opiates.