Deep continuous sedation maintained until death, in French Intensive Care Units

Dorze, Matthieu Le; Kandelman, Stanislas; Veber, Benoît; Brunel, Élodie; Baghdadi, H.; Baumann, A.; Claudot, Frédérique; Lafaye, Caroline Guibet; Gateau, Valérie; Lallemant, Florence; Boudec, Anne Le; Michel, Fabrice; Muller, Laurent; Nouette‐Gaulain, Karine; Pérrigault, Pierre-François; Plantet, Florence; Rutter, Nadège; Samain, Emmanuel; Visquesnel, Gérald

doi:10.1016/j.accpm.2019.07.008

Cited by 4 publications

(5 citation statements)

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“…Situations in which patients request continuous and deep sedation requests from patients are rare. In this particular situation, the regulatory framework states that “when a physician decide to withdraw a life-sustaining therapy to avoid potential inappropriate treatments, he/she applies continuous and deep sedation leading to an alteration of consciousness maintained until death, associated with analgesia.” 5 According to this framework, all patients should have received continuous deep sedation at the time to withdraw life-sustaining therapies. In practice, an intent of continuous and deep sedation until death affected only 60% of them.…”

Section: Discussionmentioning

confidence: 99%

“…Twenty-four hours before death, 110/208 (53%) of these patients were sedated. These patients (n = 110) were sedated with the same medicines used at lower doses (60% midazolam, 33% propofol 33%, 7% both, with median doses used of 5 [3][4][5][6][7][8][9][10] for midazolam and 150 [100-200] mg h −1 for propofol, p < 0.05 for both).…”

Section: Practice Of Continuous and Deep Sedationmentioning

confidence: 99%

“…In 2016, the law has provided a regulatory framework for its decision-making process. 4,5 In 2018 and 2020, the health authority has produced practice guidelines 6,7 (Table 1). Despite this framework, each endof-life situation requiring continuous and deep sedation is unique and raises ethical and practical issues, 8,9 particularly regarding its potential to hasten death.…”

Section: Introductionmentioning

confidence: 99%

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Continuous and deep sedation until death after a decision to withdraw life-sustaining therapies in intensive care units: A national survey

et al. 2023

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Background: Continuous and deep sedation until death is a much highly debated end-of-life practice. France is unique in having a regulatory framework for it. However, there are no data on its practice in intensive care units (ICUs). Aim: The aim is to describe continuous and deep sedation in relation to the framework in the specific context of withdrawal of life-sustaining therapies in ICUs, that is, its decision-making process and its practice compared to other end-of-life practices in this setting. Design and setting: French multicenter observational study. Consecutive ICU patients who died after a decision to withdraw life-sustaining therapies. Results: A total of 343 patients in 57 ICUs, 208 (60%) with continuous and deep sedation. A formalized procedure for continuous and deep sedation was available in 32% of the ICUs. Continuous and deep sedation was not the result of a collegial decision-making process in 17% of cases, and did not involve consultation with an external physician in 29% of cases. The most commonly used sedative medicines were midazolam (10 [5–18] mg h−1) and propofol (200 [120–250] mg h −1). The Richmond Agitation Sedation Scale (RASS) was −5 in 60% of cases. Analgesia was associated with sedation in 94% of cases. Compared with other end-of-life sedative practices ( n = 98), medicines doses were higher with no difference in the depth of sedation. Conclusions: This study shows a poor compliance with the framework for continuous and deep sedation. It highlights the need to formalize it to improve the decision-making process and the match between the intent, the practice and the actual effect.

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Section: Discussionmentioning

confidence: 99%

Section: Practice Of Continuous and Deep Sedationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Continuous and deep sedation until death after a decision to withdraw life-sustaining therapies in intensive care units: A national survey

et al. 2023

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“…En théorie, une pratique sédative en fin de vie est définie par l'utilisation surveillée de médicaments dans l'intention d'induire un état de conscience diminuée ou absente, dans le but de soulager la charge d'une souffrance réfractaire de manière éthiquement acceptable par le patent, ses proches, et les soignants. En pratique, chaque situation de leur application questionne [7]. L'intention est-elle de soulager une souffrance physique ou psychique réfractaire par une titration comme pour les sédations proportionnées, ou d'induire un état d'inconscience profond par une induction anesthésique comme c'est le cas dans la sédation profonde et continue maintenue jusqu'au décès ?…”

Section: Les Pratiques De Fin De Vie En Réanimationunclassified

La fin de vie en réanimation, une réalité complexe

Dorze

2022

Le Praticien en Anesthésie Réanimation

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“…cDCD reshapes end-of-life care by introducing the issue of organ donation before the time of death. Thus, cDCD may potentially affect not only the decision-making process leading to WLST but also other end-of-life care practices (11)(12)(13)(14). The French cDCD protocol explicitly states that decision to withdraw LST must be made in the patient's best interest, independently from any consideration regarding organ donation, and that cDCD must not alter end-of-life care (15).…”

Section: Introductionmentioning

confidence: 99%

“A Delicate balance”—Perceptions and Experiences of ICU Physicians and Nurses Regarding Controlled Donation After Circulatory Death. A Qualitative Study

Dorze

Martouzet²,

Cassiani-Ingoni³

et al. 2022

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Controlled donation after circulatory death (cDCD) is considered by many as a potential response to the scarcity of donor organs. However, healthcare professionals may feel uncomfortable as end-of-life care and organ donation overlap in cDCD, creating a potential barrier to its development. The aim of this qualitative study was to gain insight on the perceptions and experiences of intensive care units (ICU) physicians and nurses regarding cDCD. We used thematic analysis of in-depth semi-structured interviews and 6-month field observation in a large teaching hospital. 17 staff members (8 physicians and 9 nurses) participated in the study. Analysis showed a gap between ethical principles and routine clinical practice, with a delicate balance between end-of-life care and organ donation. This tension arises at three critical moments: during the decision-making process leading to the withdrawal of life-sustaining treatments (LST), during the period between the decision to withdraw LST and its actual implementation, and during the dying and death process. Our findings shed light on the strategies developed by healthcare professionals to solve these ethical tensions and to cope with the emotional ambiguities. cDCD implementation in routine practice requires a shared understanding of the tradeoff between end-of-life care and organ donation within ICU.

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Deep continuous sedation maintained until death, in French Intensive Care Units

Cited by 4 publications

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Continuous and deep sedation until death after a decision to withdraw life-sustaining therapies in intensive care units: A national survey

Continuous and deep sedation until death after a decision to withdraw life-sustaining therapies in intensive care units: A national survey

La fin de vie en réanimation, une réalité complexe

“A Delicate balance”—Perceptions and Experiences of ICU Physicians and Nurses Regarding Controlled Donation After Circulatory Death. A Qualitative Study

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