Palliative Sedation in a Specialized Unit for Acute Palliative Care in a Cancer Hospital: Comparing Patients Dying With and Without Palliative Sedation

Abstract

Palliative sedation is undergoing extensive debate. The aims of this study were to describe the practice of palliative sedation at a specialized acute palliative care unit and to study whether patients who received palliative sedation differed from patients who did not. We performed a systematic retrospective analysis of the medical and nursing records of all 157 cancer patients who died at the acute palliative care unit between 2001 and 2005. Palliative sedation, defined as continuous deep sedation prior to death, was used for 43% of all deceased patients. In 87% of the sedated patients, it was started in the last two days before death. Sedated and nonsedated patients did not differ in survival after admission (eight days vs. seven days, P=0.12). Sedated patients were younger (55 years vs. 59 years, P=0.04) and more often had malignancies of the digestive tract (P<0.01). In both groups, common symptoms at admission were pain (79% vs. 87%, P=0.23), constipation, (40% vs. 48%, P=0.46), and dyspnea (32% vs. 29%, P=0.77). On the day that palliative sedation was started, sedated patients more often suffered from dyspnea and delirium than nonsedated patients at a comparable day before death. The most important indications for palliative sedation were terminal restlessness (60%) and dyspnea (46%). We conclude that at the studied acute palliative care unit, patients who ultimately received palliative sedation did not have symptoms different than nonsedated patients at admission, but on the day at which the sedation was started, they suffered more often from delirium and dyspnea.

Clarifying Delirium Management: Practical, Evidenced-Based, Expert Recommendations for Clinical Practice

“…29,60,68,90,[109][110][111][112][113][114][115][116][117] The concurrent use of antipsychotic medications targeted at perceptual disturbances or delusions may also be warranted.…”

“…[47][48][49][50][51] In dying patients with hyperactive delirium, when the goals are to decrease agitation, relieve muscle tension, ensure amnesia, and minimize the risk of seizures, benzodiazepines appear to be ideal medications to manage and prevent these symptoms. 29,60,68,90,[109][110][111][112][113][114][115][116][117]119 Benzodiazepines. These function as sedatives, anxiolytics, skeletal muscle relaxants, amnestics, and potent antiepileptics (Table 3).…”

Palliative Sedierung auf einer universitären Palliativstation

“…Insgesamt war eine Kommunikation nur an 20 % der Tage mit pS möglich. Dabei ist zu berücksichtigen, dass 22 von 34 Patienten schon unmittelbar vor Beginn der Sedierung nicht oder nur unzureichend entscheidungsfähig waren und [18]. Grundlegend ist hier die letztlich nur definitorisch zu entscheidende Frage, ob die Gabe von Sedativa und Neuroleptika bei der terminalen Unruhe von Patienten als kausale Therapiemaßnah-me oder als palliative Sedierung infolge eines therapierefraktären Symptoms zu werten ist.…”

Ethical Decision Making With End-of-Life Care: Palliative Sedation and Withholding or Withdrawing Life-Sustaining Treatments

“…5,[9][10][11] Other programs that use primarily barbiturates, either alone or in combination with other agents, have also reported good results. [12][13][14] Our institution (Mayo Clinic, Rochester, MN) supports the use of ketamine or propofol in patients whose condition is refractory to opioids and midazolam.…”