L’essentiel des Recommandations HAS février 2020. « Antalgie des douleurs rebelles et pratiques sédatives chez l’adulte : prise en charge médicamenteuse en situations palliatives jusqu’en fin de vie »

Treillet, Erwan; Péchard, Marie; Frasca, Matthieu

doi:10.1016/j.douler.2021.01.001

Cited by 4 publications

(3 citation statements)

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“…Our study has the strength of providing a fairly detailed description of continuous and deep sedation until death in the ICU, while no guidelines have addressed this specific issue. 6 The data on medicine practice, beyond the decision-making process, are rather positive. Despite the lack of a formalized continuous and deep sedation protocol in the majority of centers, practices were homogeneous (sedative or analgesic medicines selected, doses used, monitoring scale selected) with higher doses than those recommended for end-of-life sedation in ICU patients although medicines were used within the recommended doses for ICU sedation.…”

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%