Survey of Palliative Sedation at End of Life in Terminally Ill Heart Failure Patients　― A Single-Center Experience of 5-Year Follow-up ―

Abstract

Based on a review of Palliative Care Team consultations, patients who were hospitalized for HF and died during the hospitalization despite optimal pharmacological and/or nonpharmacological therapy were selected and defined as terminally ill HF patients. We excluded patients who were intubated or receiving mechanical circulatory support at the time of death. Patients who were administered intravenous sedation within the last week at life were defined as patients receiving palliative sedation 4 and were included in this analysis. Among patients without palliative sedation, we investigated the reasons of non-usage and the patients' baseline characteristics. Palliative sedation was preceded by thorough discussion with the multidisciplinary Palliative Care Team and attending doctors, and was administered to the patients with intractable severe symptoms that were refractory to ordinary palliative care approaches at the end of life. Definition and Measurements We investigated the efficacy of palliative sedation using the Richmond Agitation-Sedation Scale (RASS). 5 Additionally, we obtained data on temporal changes in vital signs, including respiratory rate, oxygen saturation, blood pressure and heart rate, from the patients' charts. 6 These data were evaluated before treatment, approximately 1 h after starting seda-H eart failure (HF) is a progressive disease with a poor prognosis and is a major growing public health problem worldwide in aging societies. 1 Palliative care is a multidisciplinary approach to improving quality of life and is highly relevant for HF patients. 2 Palliative sedation is considered to be a therapeutic option as part of palliative care when symptoms become uncontrollable and intractable at the end of life. 3 To date, there are limited reports and no specific recommendations about palliative sedation in terminally ill HF patients. Thus, the aims of this study were to survey the practice of palliative sedation in patients with HF at a tertiary cardiovascular referral center in Japan, and to investigate the feasibility of sedative agents in terminally ill HF patients. Methods Study Design and Population This was a single-center retrospective study conducted by members of the Palliative Care Team at the National Cerebral and Cardiovascular Center, which is a tertiary cardiovascular referral center in Japan. Palliative Care Team activities commenced in September 2013 and we retrospectively reviewed consecutive patients who were hospitalized and referred to the Palliative Care Team between September

How to measure the effects and potential adverse events of palliative sedation? An integrative review

“…15 The majority of studies were conducted in palliative care services. Eight articles included sedated patients with non-malignant disease, 2,8,10,17,31,32,34,45 three did not specify a diagnosis 4,24,42 and the rest included only cancer patients.…”

“…Some studies reported assessment of vital signs when presenting their results on palliative sedation. 6,44,45…”

“…2,7,8,10,13,[15][16][17]31,32,34,35,37,39,40 Six studies were conducted retrospectively through chart or clinical documents review. 4,12,13,30,41,45 Cochrane: limited specifically to Cochrane reviews as this database pulls data from Pubmed and Embase, and these databases had been already searched Medline: limit of "journal articles" (referring to empirical journal articles) or "reviews" Table 2. Inclusion and exclusion criteria.…”

Off-label dexmedetomidine use in palliative patients

“…Deksmedetomidyna stosowana jest również w sedacji u chorych wentylowanych mechanicznie, można ją bezpiecznie stosować również w bezpośrednim okresie po ekstubacji. Do rozważenia jest jej użycie w czasie procedur chirurgicznych, gdy waż-na jest współpraca chorego z lekarzem przy jednoczesnym zachowaniu świadomości [23,24].…”

Dexmedetomidine for hyperactive delirium at the end of life: An open-label single arm pilot study with dose escalation in adult patients admitted to an inpatient palliative care unit

“…6,14 The evidence for its efficacy in palliative care is more limited 11 with case reports for its use showing positive analgesic benefits in advanced cancer 15,16 and a retrospective chart analysis showing a benefit in the treatment of delirium in patients with cardiac disease. 17 Hofherr et al 18 report on two cases of its use in terminal delirium using an adapted ICU protocol, without cardiac monitoring on an inpatient palliative care ward. These promising results, as well as the characteristics of reduced delirium and increased rousablility, make dexmedetomidine a potentially favourable option for managing confusion and pain at the end of life.…”