Belar Alazne, Arantzamendi María, Payne Sheila, Preston Nancy, Rijpstra Maaike, Hasselaar Jeroen, Radbruch Lukas, Vanderelst Michael, Ling Julie, Centeno Carlos
Institute for Culture and Society-ATLANTES, Universidad de Navarra, Pamplona, Spain.
IdISNA, Pamplona, Spain.
Palliat Med. 2021 Feb;35(2):295-314. doi: 10.1177/0269216320974264. Epub 2020 Dec 14.
Palliative sedation is the monitored use of medications intended to relieve refractory suffering. The assessment of palliative sedation has been focused on the assess of the level of consciousness but a more comprehensive approach to assessment is needed.
To understand how the potential effects and possible adverse events of palliative sedation in Palliative Care patients are measured.
Integrative review of most recent empirical research.
Cochrane Library, Embase, Medline, PubMed, and CINAHL were searched (2010-2020) using the terms sedation, palliative care, terminal care, assessment. Limits included studies in English and adults. Inclusion criteria were: scientific assessment papers, effects and complications of palliative sedation; patients with incurable illness.
Out of 588 titles, 26 fulfilled inclusion criteria. The Discomfort Scale-Dementia of Alzheimer Type and Patient Comfort Score were used to assess comfort. The Richmond Agitation-Sedation Scale and The Ramsay Sedation Scale are the most used to measure its effect. Refractory symptoms were assessed through multi-symptom or specific scales; except for psychological or existential distress. Delirium was assessed using the Memorial Delirium Assessment Scale and pain through the Critical Care Pain Observation Tool. The use of technical approaches to monitor effects is upcoming. There is lack of measurement of possible adverse events and variability in timing measurement.
There are palliative care validated instruments to assess the sedation effect but this review shows the need for a more standardized approach when assessing it. Instruments should be used within an experienced and trained expert, providing a holistic assessment.
姑息性镇静是指在监测下使用药物以缓解难治性痛苦。对姑息性镇静的评估一直侧重于意识水平的评估，但需要一种更全面的评估方法。
了解如何衡量姑息性镇静对姑息治疗患者的潜在影响和可能的不良事件。
对最新实证研究的综合综述。
使用术语“镇静”“姑息治疗”“终末期护理”“评估”检索了考克兰图书馆、Embase、Medline、PubMed和CINAHL（2010 - 2020年）。限制条件包括英语研究和成人研究。纳入标准为：科学评估论文、姑息性镇静的效果和并发症；患有不治之症的患者。
在588篇标题中，26篇符合纳入标准。使用阿尔茨海默病型痴呆不适量表和患者舒适度评分来评估舒适度。里士满躁动 - 镇静量表和拉姆齐镇静量表是最常用于衡量其效果的量表。难治性症状通过多症状或特定量表进行评估；心理或存在性痛苦除外。使用纪念谵妄评估量表评估谵妄，使用重症监护疼痛观察工具评估疼痛。监测效果的技术方法即将出现。缺乏对可能不良事件的测量以及测量时间的变异性。
有经姑息治疗验证的工具来评估镇静效果，但本综述表明在评估时需要一种更标准化的方法。工具应在经验丰富且经过培训的专家指导下使用，进行全面评估。
