Palliative sedation in patients hospitalized in internal medicine departments.
J Pain Symptom Manage. 2019 Oct 23;:
Authors: Díez-Manglano J, de Isasmendi Pérez SI, Fenoll RG, Sánchez LÁ, Formiga F, Galvañ VG, Dueñas C, Villanueva BR, Díaz CE, Vales EC, UDMIVI study researchers
CONTEXT: Palliative sedation is used to relieve end-of-life refractory symptoms.
OBJECTIVE: To describe the use of palliative sedation in patients who die in internal medicine departments.
METHODS: An observational, cross-sectional, retrospective and multicenter, clinical audit study was conducted in 145 hospitals in Spain and Argentina. Each hospital included the first 10 patients who died in the internal medicine department, starting on December 1, 2015.
RESULTS: We included 1447 patients, and palliative sedation was administered to 701 (48.4%). Having a terminal illness (OR 2.469, 95%CI 1.971-3.093, p<0.001) and the length of the hospital stay (OR 1.011, 95%CI 1.002-1.021, p=0.017) were independently associated with the use of palliative sedation. Consent was granted by the families of 582 (83%) patients. The most common refractory symptom was dyspnea, and the most commonly used drugs for sedation were midazolam (77%) and morphine (89.7%). An induction dose was administered in 25.7% of the patients. Rescue doses were scheduled for 70% of the patients, and hydration was maintained in 49.5%. Pain was more common in patients with cancer, while dyspnea was more common in those without cancer. Rescue doses were employed more often for the patients with cancer (77.8% vs. 67.7%, p=0.015). Monitoring the palliative sedation with a scale was more frequent in the patients with cancer (23.7% vs. 14.3%, p=0.008).
CONCLUSIONS: Palliative sedation is employed more often for terminal patients. There are differences in the administration of palliative sedation between patients with and without cancer.
PMID: 31655190 [PubMed - as supplied by publisher]