Pediatric Palliative Care Team, Hospital Nacional Professor Alejandro Posadas, Buenos Aires, Argentina.
Curr Opin Support Palliat Care. 2011 Sep;5(3):285-90. doi: 10.1097/SPC.0b013e3283492aba.
This article is aimed to review updated research on end-of-life care sedation (EOLC-S) for children and aspects surrounding this issue.
Prevalence of EOLC-S for children may vary across countries on account of cultural differences, in terms of settings, legal issues and perceptions about EOLC-S, which lead to variation in patient selection and management. Although home is the preferred place of death for families, research shows hospital settings and ICUs to be the most frequent places where children die. Data on how to define refractory symptoms and update research on drug selection and dosing are lacking. Nature of symptoms at end of life (EOL) is described for cancer patients, but few articles focused on nononcological conditions. Decision making at EOL is commonly discussed with families but children are less frequently involved.
A thorough search of databases was conducted for articles published in the last year. We found few articles describing EOLC-S as a last resort. But how, when and by whom a symptom is defined as refractory, is not well established. Aggressive symptom management at EOL along with advanced care planning conducted by pediatric palliative care teams could diminish EOLC-S. More research is needed.
本文旨在综述儿童生命终末期镇静（EOLC-S）的最新研究，并探讨该领域的相关问题。
由于文化差异，EOLC-S 在各国的流行程度可能存在差异，具体表现在环境、法律问题和对 EOLC-S 的看法方面，这些差异导致了患者选择和管理的差异。尽管家庭是死亡的首选地点，但研究表明，医院环境和 ICU 是儿童死亡最常见的地方。缺乏关于如何定义难治性症状以及更新药物选择和剂量的研究数据。生命终末期（EOL）的症状性质已在癌症患者中描述，但很少有文章关注非肿瘤疾病。在 EOL 时，通常与家属讨论决策，但很少让儿童参与。
对过去一年发表的文章进行了全面的数据库搜索。我们发现很少有文章将 EOLC-S 描述为最后的手段。但是，如何、何时以及由谁来定义症状为难治性，尚未得到很好的确定。在生命终末期进行积极的症状管理，并由儿科姑息治疗团队进行先进的护理计划，可能会减少 EOLC-S 的使用。需要进一步的研究。
