Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Division of Palliative Care, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
PLoS One. 2022 Jul 8;17(7):e0270483. doi: 10.1371/journal.pone.0270483. eCollection 2022.
Palliative sedation is used to relieve refractory symptoms and is part of clinical practice in Sweden. Yet we do not know how frequently this practice occurs, how decision-making takes place, or even which medications are preferentially used.
To understand the current practice of palliative sedation in Sweden.
We conducted a retrospective cross-sectional medical record-based study. For 690 consecutive deceased patients from 11 of 12 specialized palliative care units in the southernmost region of Sweden who underwent palliative sedation during 2016, we collected data on whether the patient died during sedation and, for sedated patients, the decision-making process, medication used, and depth of sedation.
Eight percent of patients were sedated. Almost all (94%) were given midazolam, sometimes in combination with propofol. The proportions of sedation were similar in the patient groups with and without cancer. The largest proportion of the sedated patients died in inpatient care, but 23% died at home, with specialized palliative home care. Among the patients with a decision to sedate, 42% died deeply unconscious, while for those without such a decision the corresponding figure was 16%. In only one case was there more than one physician involved in the decision to use palliative sedation.
8% of patients in specialized palliative care received palliative sedation, which is lower than international measures but much increased compared to an earlier Swedish assessment. The level of consciousness achieved often did not correspond to the planned level; this, together with indications of a scattered decision process, shows a need for clear guidelines.
缓和性镇静用于缓解难治性症状，是瑞典临床实践的一部分。然而，我们不知道这种做法的频率如何、决策过程如何，甚至不知道优先使用哪些药物。
了解瑞典目前的缓和性镇静实践情况。
我们进行了一项回顾性、基于病历的横断面研究。对瑞典南部 12 个专门的姑息治疗单位中的 11 个单位在 2016 年期间接受过缓和性镇静的 690 名连续死亡患者进行了研究，收集了患者是否在镇静期间死亡以及接受镇静的患者的决策过程、使用的药物和镇静深度的数据。
8%的患者接受了镇静。几乎所有（94%）患者都使用了咪达唑仑，有时与丙泊酚联合使用。有和没有癌症的患者组的镇静比例相似。接受镇静的患者中，最大比例的人在住院治疗中死亡，但 23%的人在接受专门的姑息性家庭护理的家中死亡。在决定镇静的患者中，42%的人处于深度无意识状态，而对于没有这种决定的患者，相应的比例为 16%。在只有一个病例中，有不止一位医生参与使用缓和性镇静的决策。
专门的姑息治疗中 8%的患者接受了缓和性镇静，这低于国际标准，但比瑞典早期的评估大大增加。达到的意识水平往往与计划的水平不符；这与决策过程分散的迹象一起表明需要明确的指导方针。
