Mercadante Sebastiano, Porzio Giampiero, Valle Alessandro, Aielli Federica, Casuccio Alessandra
Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy; Palliative Medicine, Department of Anesthesia & Intensive Care, University of Palermo, Palermo, Italy.
Home Care Program, L' Aquila per la vita, L'Aquila, Italy.
J Pain Symptom Manage. 2014 May;47(5):860-6. doi: 10.1016/j.jpainsymman.2013.06.019. Epub 2013 Oct 5.
Home care programs in Italy.
The aim of this study was to assess a protocol for palliative sedation (PS) performed at home.
A total of 219 patients were prospectively assessed to evaluate a PS protocol in patients with advanced cancer followed at home by two home care programs with different territorial facilities. The protocol was based on stepwise administration of midazolam.
A total of 176 of the patients died at home, and PS was performed in 24 of these patients (13.6%). Younger patients received the procedure more frequently than older patients (P=0.012). The principal reasons to start PS were agitated delirium (n=20) and dyspnea (n=4). Mean duration of PS was 42.2±30.4 hours, and the mean doses of midazolam were 23-58 mg/day. Both the home care team and the patients' relatives expressed optimal or good levels of satisfaction with the procedure in all but one case, respectively.
This protocol for PS was feasible and effective in minimizing distress for a subgroup of patients who died at home. The characteristics of patients who may be effectively sedated at home should be better explored in future studies.
意大利的居家护理项目。
本研究旨在评估一项在家中实施的姑息性镇静（PS）方案。
前瞻性评估了总共219例患者，以评价在两个具有不同地域设施的居家护理项目下，对晚期癌症患者实施的PS方案。该方案基于咪达唑仑的逐步给药。
总共176例患者在家中死亡，其中24例（13.6%）接受了PS。年轻患者接受该操作的频率高于老年患者（P = 0.012）。启动PS的主要原因是激越性谵妄（n = 20）和呼吸困难（n = 4）。PS的平均持续时间为42.2±30.4小时，咪达唑仑的平均剂量为23 - 58毫克/天。除1例患者外，居家护理团队和患者亲属分别对该操作表示了最佳或良好的满意度。
该PS方案在使在家中死亡的一部分患者的痛苦最小化方面是可行且有效的。未来研究应更好地探索可能在家中有效镇静的患者特征。
