Dexmedetomidine and Propofol at End of Life in Pediatric Oncology: Trends in Palliative Sedation Therapy

Cuviello, Andrea; Pasli, Melisa; Bhatia, Shalini; Johnson, Liza‐Marie; Anghelescu, Doralina L.; Baker, Justin N.

doi:10.1089/jpm.2021.0650

Cited by 6 publications

(4 citation statements)

References 39 publications

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“…28,29 In a single-institution 10-years review of pediatric PST in pediatric oncology, dexmedetomidine infusions were used in 87% of patients, starting at low doses (0.2 mcg/kg/hr) and escalated as needed for symptom relief or suffering; in 17% of cases, symptom relief required the use of propofol for PST. 39 This latter study is the largest reported cohort involving dexmedetomidine use at the EOL and highlights the need for further research in this area. Overall, the variation observed in medication selection for PST in our survey supports the need for a clinical practice update and standardization.…”

Section: Discussionmentioning

confidence: 82%

“…55,56 Furthermore, Mcleod et al found that between 1998 and 2010, there was a slow decline in survey response rates among physicians and other healthcare providers across all platforms. 57 For our survey, we attribute the low response rate to the fact that some providers may not perform PST, considering it is a rare circumstance; 39 some recipients are not physicians within the professional societies SPPM or AAHPM, and thus did not meet criteria to complete the survey. The majority of respondents were from large academic centers, which may reflect the large volume of patients required to encounter a situation necessitating PST.…”

Section: Discussionmentioning

confidence: 99%

“…Literature suggests that the need for PST is rare in pediatrics; a recent retrospective review of pediatric oncology deaths reported a 3% incidence of PST. 39 Our study participants' responses, primarily representing large academic institutions, reflects academia as driving innovative research and clinical practice to deliver cutting edge services like PST for EOL care. The variability in PST practices may be due to inconsistent educational efforts on PST and a lack of standardization of care, pointing toward areas in need of improvement.…”

Section: Discussionmentioning

confidence: 99%

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Palliative Sedation Therapy Practice Comparison – A Survey of Pediatric Palliative Care and Pain Management Specialists

Cuviello

Ang

Morgan

et al. 2022

Am J Hosp Palliat Care

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Context: Palliative sedation therapy (PST) can relieve suffering at end-of-life (EOL) in children with intolerable and refractory symptoms. However, updated and consistent guidance on PST practices are imperative. Objectives: We investigate current variations in clinical practice and PST implementation among pediatric palliative care (PPC) and pain management (PM) specialists. Methods: We distributed an IRB-exempt electronic anonymous survey via email through the Society of Pediatric Pain Medicine, and the American Academy of Hospice and Palliative Medicine. Survey responses were collated and descriptively reported. Results: Of 83 survey responses, the majority (75%) represented large academic children’s hospitals. The distribution between PPC and pediatric pain management specialists’ responses was 60% and 40%, respectively. Most respondents reported having designated pain management and/or palliative care teams (70% and 90%, respectively). Approximately half (48%) reported following an institutional PST protocol, most not requiring formal ethics consult (69%). Only 54% of respondents noted that the Do Not Resuscitate (DNR) order was required prior to PST initiation. PST was primarily utilized for children with oncologic diagnoses (76%). The primary and secondary medications of choice for PST implementation were reported to be opioids (39%) and benzodiazepines (36%) by pain management specialists, and benzodiazepines (52%) and barbiturates (28%) by palliative care specialists. Conclusions: Our study highlights the variability in the practice and implementation of PST. Further educational efforts are key for establishing PST practices and efficient protocol development.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Palliative Sedation Therapy Practice Comparison – A Survey of Pediatric Palliative Care and Pain Management Specialists

Cuviello

Ang

Morgan

et al. 2022

Am J Hosp Palliat Care

Self Cite

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“…To our knowledge, no previous study has examined such a large sample of pediatric patients treated with PS. In a broader context, the above rates of incidence are lower (Libro-de-ponenciasy-comunicaciones-III-Congreso-PedPal.pdf 2019) or similar to those reported in some cases (Chen et al 2022;Korzeniewska-Eksterowicz et al 2014;Vallero et al 2014) but higher than has been published in other, recent, publications (Cuviello et al 2023;de Noriega et al 2021;Maeda et al 2020). These discrepancies might be explained, at least in part, by the existence of differences between the respective study cohorts and by the lack of a unified definition.…”

Section: Discussionmentioning

confidence: 48%

Sedation in pediatric palliative care: The role of pediatric palliative care teams

Peláez Cantero,

Morales Asencio,

Parra Plantagenet-Whyte

et al. 2023

Pall Supp Care

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Objectives Palliative sedation (PS) consists of the use of drugs to alleviate the suffering of patients with refractory symptoms, through a reduction in consciousness. The aim of this study is to describe the incidence of and indications for PS in patients treated by pediatric palliative care teams (PPCT), and the relationship between PS, the place of death, and the characteristics of the care teams. Methods Ambispective study with the participation of 14 PPCT working in Spain. Results From January to December 2019, a total of 164 patients attended by these PPCT died. Of these, 83 (50.6%) received PS during their last 24 hours. The most frequent refractory symptoms were terminal suffering (n = 40, 48.2%), dyspnea (n = 9, 10.8%), pain (n = 8, 9.6%), and convulsive state (n = 7, 8.4%). Sedation in the last 24 hours of life was more likely if the patient died in hospital, rather than at home (62.9% vs. 33.3%, p < 0.01); if the parents had not expressed their preference regarding the place of death (69.2% vs. 45.2%, p = 0.009); and if the PPCT had less than 5 years’ experience (66.7% vs. 45.5%, p = 0.018). Significance of results PS is a real possibility in pediatric end-of-life care and relates to care planning and team expertise.

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Utilization of Palliative Radiation in Pediatric Oncology Patients During the End-of-Life (EOL)

Cuviello,

Figueroa Guzmán,

Zeng

et al. 2024

Journal of Pain and Symptom Management

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Dexmedetomidine and Propofol at End of Life in Pediatric Oncology: Trends in Palliative Sedation Therapy

Cited by 6 publications

References 39 publications

Palliative Sedation Therapy Practice Comparison – A Survey of Pediatric Palliative Care and Pain Management Specialists

Palliative Sedation Therapy Practice Comparison – A Survey of Pediatric Palliative Care and Pain Management Specialists

Sedation in pediatric palliative care: The role of pediatric palliative care teams

Utilization of Palliative Radiation in Pediatric Oncology Patients During the End-of-Life (EOL)

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