CHU de Nantes, Service de Soins Palliatifs et de Support, Nantes Université, Nantes, France.
CHU de Nantes, Pharmacie, Nantes Université, Nantes, France.
BMJ Support Palliat Care. 2024 Feb 21;14(1):60-64. doi: 10.1136/spcare-2023-004551.
Limited descriptive data are available on continuous and deep sedation maintained until death (CDSUD) at the patient's request in palliative care units. This study aimed to describe such practices in the context of refractory suffering or after a request to stop life-sustaining treatment, evaluating the duration and dosage of sedative treatments used.
This retrospective observational study included consecutively hospitalised patients in a palliative care unit from January 2020 to December 2021. Data on patient profiles, reasons for the sedation request, duration of sedation and doses of sedatives were collected.
Among 42 patients who underwent CDSUD, 79% occurred due to refractory suffering. In cases of sedation following a request to stop life support, high-dose corticosteroid therapy was the most commonly involved life-sustaining treatment. Midazolam was always the first-line sedative treatment. Chlorpromazine was added in 79% of cases, and propofol in 40%, to achieve a deep level of sedation. The mean maximum doses of midazolam, chlorpromazine and propofol were 7.6 mg/hour (±1.9), 3.3 mg/hour (±0.9) and 1.7 mg/kg/hour, respectively. The average duration of sedation was 37 hours.
This study provides new descriptive elements on CDSUD. Notably, it highlights the use of second-line sedative molecules, such as propofol.
在姑息治疗病房中，应患者要求持续进行深度镇静直至死亡（CDSUD）的描述性数据有限。本研究旨在描述这种做法在难治性痛苦或停止生命支持治疗的请求背景下的情况，并评估使用的镇静治疗的持续时间和剂量。
本回顾性观察性研究纳入了 2020 年 1 月至 2021 年 12 月期间在姑息治疗病房住院的连续患者。收集了患者特征、镇静请求的原因、镇静持续时间和镇静剂剂量的数据。
在 42 例接受 CDSUD 的患者中，79%是由于难治性痛苦。在因停止生命支持治疗而进行镇静的情况下，高剂量皮质类固醇治疗是最常见涉及的生命支持治疗。咪达唑仑始终是一线镇静治疗药物。在 79%的病例中添加了氯丙嗪，在 40%的病例中添加了丙泊酚，以达到深度镇静水平。咪达唑仑、氯丙嗪和丙泊酚的最大平均剂量分别为 7.6mg/小时（±1.9）、3.3mg/小时（±0.9）和 1.7mg/kg/小时。镇静的平均持续时间为 37 小时。
本研究提供了关于 CDSUD 的新描述性元素。值得注意的是，它强调了二线镇静药物分子的使用，如丙泊酚。
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