Department of Palliative Medicine, University Hospital Munich, LMU Munich, Munich, Germany.
Palliat Med. 2018 Jul;32(7):1189-1197. doi: 10.1177/0269216318764095. Epub 2018 Mar 20.
Sedatives are frequently used towards the end of life. However, there is scarce information when their use is labelled as 'palliative sedation'.
To assess the use and labelling of 'continuous administration of sedatives within the last 7 days of life', based on objective operational criteria, on a palliative care unit.
Retrospective cohort study, using medical records. Explorative statistical analysis (SPSS 23).
SETTING/PARTICIPANTS: Patients who died on a palliative care unit from August 2014 to July 2015. Sedatives recorded were benzodiazepines, levomepromazine, haloperidol ⩾5 mg/day and propofol.
Of the 192 patients, 149 (78%) patients received continuous sedatives within the last week of life. The prevalence of delirium/agitation was significantly higher in patients with continuous sedatives compared to those without continuous sedatives at admission to the unit (35% vs 16%, p = 0.02) and on the day before death (58% vs 40%, p = 0.04). The term '(palliative) sedation' was used in the records for 22 of 149 (15%) patients with continuous sedatives. These patients had significantly higher total daily midazolam doses 2 days before death (median (range), 15.0 (6.0-185.0) mg vs 11.5 (1.0-70.0) mg, p = 0.04) and on the day of death (median (range), 19.5 (7.5-240.0) mg vs 12.5 (2.0-65.0) mg, p = 0.01). The dose range was large in both groups.
The prevalence of delirium/agitation was associated with the administration of continuous sedatives. There was no consistent pattern regarding labelling the use of continuous sedatives as '(palliative) sedation'. Multicentre mixed-methods research is needed for a better characterization of sedation practices in palliative care.
镇静剂在生命末期经常被使用。然而，当它们被标记为“姑息性镇静”时，相关信息却十分匮乏。
根据客观操作标准，评估在姑息治疗病房中，“生命最后 7 天内持续使用镇静剂”的使用和标记情况。
使用病历的回顾性队列研究。探索性统计分析（SPSS 23）。
设置/参与者：2014 年 8 月至 2015 年 7 月在姑息治疗病房死亡的患者。记录的镇静剂为苯二氮䓬类、左美丙嗪、氟哌啶醇 ⩾5mg/天和丙泊酚。
在 192 名患者中，149 名（78%）患者在生命的最后一周内接受了持续镇静治疗。与入院时未接受持续镇静治疗的患者相比，在进入病房时（35%比 16%，p=0.02）和死亡前一天（58%比 40%，p=0.04）有连续镇静剂的患者出现谵妄/激越的比例明显更高。在有连续镇静剂的 149 名患者中，有 22 名（15%）患者的记录中使用了“（姑息性）镇静”一词。这些患者在死亡前 2 天的咪达唑仑总日剂量明显更高（中位数（范围），15.0（6.0-185.0）mg 比 11.5（1.0-70.0）mg，p=0.04），在死亡当天的咪达唑仑总日剂量也明显更高（中位数（范围），19.5（7.5-240.0）mg 比 12.5（2.0-65.0）mg，p=0.01）。两组的剂量范围都很大。
谵妄/激越的发生与连续镇静剂的使用有关。连续镇静剂的使用是否被标记为“（姑息性）镇静”并没有一致的模式。需要进行多中心混合方法研究，以更好地描述姑息治疗中的镇静实践。
