Enquête du centre national des soins palliatifs et de la fin de vie sur la sédation profonde et continue jusqu’au décès (SPCJD) à 3 ans de la loi Claeys-Leonetti

Sedation practices in palliative care services across France: a nationwide point-prevalence analysis

“… 22 Physicians accustomed to the use of sedative drugs, such as anaesthesiologists, may also have performed palliative sedation without referring to a palliative care team. 14 Consultation with experts is yet highly recommended to secure adequate support from relatives and caregivers with respect to the complex decision-making process and to prevent unnecessary sedation. 2 5 23 24 Underuse of sedative practices by investigators is unlikely.…”

“…Most of them had small sample sizes. 14 Uncertainty about the prevalence in a specialised framework of care is problematic for both specialised and non-specialised caregivers, who cannot verify their practices, patients and their relatives, who may have questions about access to this care, and investigators of large-scale research projects.…”

Nationwide Study of Continuous Deep Sedation Practices Among Pediatric Palliative Care Teams

“…However, these statistics include all scenarios of CDS: those with intact decision making capacity who had uncontrollable suffering (as in our study), but also those who requested withdrawal of life-sustaining treatment, those who were unable to make or execute decisions themselves, or other undefined scenarios. In any case, sedation performed upon patient request remains a minority, estimated at 15-16% of all CDS practices (15,16). Literature on the pediatric population is scarce and few studies have explored CDS practices in children, adolescents and young adults.…”

“…Following up psychological evaluation with reinforced mental health care is an essential element of CDS procedures. Contrary to adult literature in which collegial discussion of CDS requests ranges from 60-90% (16,21), all of our cases were analysed collegially as mandated by French law. As there can be a gap between what is legally desired and the clinical reality, it is important to emphasize that collegiality was constantly upheld in pediatrics.…”

“…Once CDS was decided, sedation was induced using Midazolam in all cases, mainly via titration. However, maximum Midazolam doses were up to triple recommended adult doses (6, 16,21,28).…”