Tejero Elena, Pardo Paloma, Sánchez-Sánchez Sonia, Galera Raúl, Casitas Raquel, Martínez-Cerón Elisabet, García-Rio Francisco
Servicio de Urgencias, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain.
Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
Respiration. 2021;100(1):1-10. doi: 10.1159/000510537. Epub 2020 Dec 18.
Although patients with chronic obstructive pulmonary disease (COPD) receive poor-quality palliative care, information about the use of palliative sedation (PS) in the last days of life is very scarce.
To compare the use of PS in hospitalized patients who died from COPD or lung cancer and identify factors correlating with PS application.
In a retrospective observational cohort study, from 1,675 patients died at a teaching hospital between 2013 and 2015, 109 patients who died from COPD and 85 from lung cancer were compared. Sociodemographic data, clinical characteristics, health care resource utilization, application of PS and prescribed drugs were recorded.
In the last 6 months of life, patients who died from COPD had more hospital admissions due to respiratory causes and less frequent support by a palliative home care team (PHCT). Meanwhile, during their last hospitalization, patients who died from COPD had fewer do-not-resuscitate orders and were subjected to more intensive care unit admissions and cardiopulmonary resuscitation maneuvers. PS was applied less frequently in patients who died from COPD than in those who died from lung cancer (31 vs. 53%, p = 0.002). Overall, previous use of opioid drugs, support by a PHCT, and a diagnosis of COPD (adjusted odds ratio 0.48, 95% CI: 0.26-0.89, p = 0.020) were retained as factors independently related to PS. In COPD patients, only previous use of opioid drugs was identified as a PS-related factor.
During their last days of life, hospitalized COPD patients receive PS less frequently than patients with lung cancer.
尽管慢性阻塞性肺疾病（COPD）患者接受的姑息治疗质量较差，但关于临终时使用姑息性镇静（PS）的信息非常匮乏。
比较死于COPD或肺癌的住院患者使用PS的情况，并确定与PS应用相关的因素。
在一项回顾性观察队列研究中，对2013年至2015年间在一家教学医院死亡的1675例患者中，109例死于COPD的患者和85例死于肺癌的患者进行了比较。记录了社会人口统计学数据、临床特征、医疗资源利用情况、PS的应用及处方药物。
在生命的最后6个月里，死于COPD的患者因呼吸原因住院的次数更多，接受姑息家庭护理团队（PHCT）支持的频率更低。同时，在他们最后一次住院期间，死于COPD的患者的不复苏医嘱较少，入住重症监护病房和进行心肺复苏操作的次数更多。死于COPD的患者比死于肺癌的患者使用PS的频率更低（31%对53%，p = 0.002）。总体而言，先前使用阿片类药物、PHCT的支持以及COPD诊断（调整后的优势比为0.48，95%可信区间：0.26 - 0.89，p = 0.020）被确定为与PS独立相关的因素。在COPD患者中，仅先前使用阿片类药物被确定为与PS相关的因素。
在临终期间，住院的COPD患者使用PS的频率低于肺癌患者。
