Context: Limited information is available regarding the detailed clinical patterns of palliative sedation (PS), that is, the symptom control rate, salvage medication, and the effectiveness of intermittent PS (IPS) versus continuous PS (CPS).
Objectives: The primary aim was to investigate clinical outcomes of PS in a real clinical setting.
Methods: Clinical information was prospectively collected for patients who were treated according to a prescribed protocol and assessment tools in a hospice unit affiliated with a tertiary cancer center between September 2015 and March 2017. Data were analyzed retrospectively. Midazolam was used as the first medication for PS, and propofol and phenobarbital were subsequently used as salvage medications. Indications of PS, the depth of sedation, the quality of sleep, and the level of consciousness were assessed.
Results: A total of 306 patients were enrolled, 89 of whom (29.1%) received PS. No difference in survival time was found between patients with and without PS (median survival, 34.0 vs 25.0 days, P = 0.109). Delirium was the most common indication of PS. The symptoms of 73 (82.0%) of 89 patients with PS were relieved with midazolam. Twelve (75.0%) of 16 midazolam-failure patients responded to propofol, five of whom (31%) exhibited respiratory depression. Of the 89 patients receiving PS, 61 (68.5%) received IPS and 28 patients (31.5%) received CPS. The median survival times from PS initiation to death were six days in the IPS group and one day in the CPS group (P < 0.001). Interestingly, consciousness levels were significantly improved after IPS in the delirium group compared with those in the other group (41.7% vs 16.7%, P = 0.002).
Conclusion: The refractory symptoms of end-of-life patients with cancer can ultimately be relieved with various medications for PS. IPS may improve the consciousness level of patients with delirium.
Keywords: Sedatives; continuous palliative sedation; intermittent palliative sedation; survival.
Copyright © 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Continuous Palliative Sedation for Patients With Advanced Cancer at a Tertiary Care Cancer CenterBL Prado et al. BMC Palliat Care 17 (1), 13. PMID 29301574.PS is a relatively common practice in the end-of-life of cancer patients at our hospital and it is not associated with shortening of hospital stay. Involvement of a dedic …
Palliative Sedation at the End of Life: Patterns of Use in an Israeli HospiceD Azoulay et al. Am J Hosp Palliat Care 33 (4), 369-73. PMID 25701661.Palliative sedation (PS) is indicated for refractory symptoms among dying patients. This retrospective descriptive study examines PS in an Israeli hospice. Palliative sed …
[Palliative Sedation at a University Palliative Care Unit--A Descriptive Analysis]A Hopprich et al. Dtsch Med Wochenschr 141 (8), e60-6. PMID 27078251.pS was successfully used as last resort for relief of treatment-refractory symptoms in one third of decedents at the investigated palliative care unit.
[Palliative Sedation]EH Verhagen et al. Ned Tijdschr Geneeskd 149 (9), 458-61. PMID 15771339. - ReviewPalliative sedation is the intentional lowering of the level of consciousness ofa patient in the last phase of life by means of the administration of sedatives. The objec …
Palliative Pharmacological Sedation for Terminally Ill AdultsEM Beller et al. Cochrane Database Syst Rev 1 (1), CD010206. PMID 25879099. - ReviewThere was insufficient evidence about the efficacy of palliative sedation in terms of a person's quality of life or symptom control. There was evidence that palliative se …