Palliative sedation for children at end of life: a retrospective cohort study

Abstract

Background Palliative sedation is consciously reducing the patient’s consciousness to alleviate the refractory symptoms. However, studies on palliative sedation for children are scarce. We aimed to survey the symptom control and risks for children with sedative therapy in end of life. Method This study was a single center retrospective cohort study. Children who died in the Department of Palliative Medicine were divided into palliative sedation (Group A) and non-palliative sedation group (Group B). The symptoms relief, survival time, and last hospitalization time were compared between two groups. Results From January 2012 to November 2019, 41 children died in department of palliative care. 24 children were sedated (Group A), meanwhile 17 children were not (Group B). The symptoms in Group A were more complex than Group B (p = 0.013). Overall symptom relief in Group A was higher than that in Group B (24/24, 10/15 p = 0.041). Pain relief rates (7/7, 20/21 p = 0.714), maximum/pre-death opioid dose [30(20, 77.5), 18(9, 45) p = 0.175, 30(20, 60), 18(9, 45) p = 0.208] and pain intensity difference [5(4,6.5), 4(2,6) p = 0.315] did not differ significantly in either groups. After diagnosis, the survival time of the Group A was longer than the Group B (p = 0.047). However, the length of hospitalization before death was similar in two groups (p = 0.385). Conclusion Palliative sedation controls complicated, painful symptoms at the end of life and does not shorten the hospitalization time in children.

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

“…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.…”

“…Several studies of this question, referring to palliative care for adults, have been published, mainly focusing on the development of clinical guidelines (Cherny 2014;Cherny and Radbruch 2009;guia_sedaccion_paliativa.pdf 2021), and usually based on expert opinion and retrospective reviews. In contrast, hardly any case series have been published with respect to the pediatric population (Chen et al 2022;de Noriega et al 2021;Kiman et al 2011), although this lack of data does not mean that the practice is uncommon (Korzeniewska-Eksterowicz et al 2014). More knowledge is needed of the habitual approaches of health-care professionals regarding pediatric PS, and of the clinical and contextual circumstances in which it is carried out, in order to identify areas for improvement, and to provide indications for future research, thus strengthening the evidence supporting protocols and guidelines for clinical practice.…”

Terminal Withdrawal of Mechanical Ventilation in a PICU

“…It has also been recognized that appropriate dosing of these medications may actually prolong life. 9,10 In any case, these medications are critically important therapies for dying pediatric patients, 11,12 which is why we take care to avoid the commonly used phrase "withdrawal of care." Even when lifesustaining technologies are withdrawn, we continue to provide active and aggressive care to our dying patients, including management of physical symptoms and existential distress, as well as family support via the interdisciplinary team.…”