Background: Sedatives are frequently used towards the end of life. However, there is scarce information when their use is labelled as 'palliative sedation'.
Aim: 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.
Design: 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.
Results: 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.
Conclusion: 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.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1177/0269216318764095 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Detection of neurologic changes in critically ill infants using deep learning on video data: a retrospective single center cohort study.
EClinicalMedicine
December 2024
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Background: Infant alertness and neurologic changes can reflect life-threatening pathology but are assessed by physical exam, which can be intermittent and subjective. Reliable, continuous methods are needed. We hypothesized that our computer vision method to track movement, pose artificial intelligence (AI), could predict neurologic changes in the neonatal intensive care unit (NICU).
View Article and Find Full Text PDFMaintenance treatment of catatonia with benzodiazepines: A case series and literature review.
Neuropsychopharmacol Hung
December 2024
College of Medicine, University of Kentucky, Lexington, KY 40506, USA.
Objective: Benzodiazepines, particularly lorazepam, are good options for acute catatonia treatment. Published catatonia literature on benzodiazepine maintenance treatment and benzodiazepine tolerance is limited.
Methods: This is a chart review covering 30 years of clinical experience in the state of Kentucky, (United States of America), where there was no easy access to electroconvulsive therapy.
[Clinical update in critical care of pulmonary medicine 2024].
Zhonghua Jie He He Hu Xi Za Zhi
January 2025
College of Pulmonary & Critical Care Medicine, Chinese PLA General Hospital, Beijing100091, China.
This review outlines significant clinical research developments in the field of critical care respiratory medicine from October 2023 to September 2024. In the post-pandemic era, the new global definition of acute respiratory distress syndrome (ARDS) has improved practicality and early warning capabilities, although further refinement through respiratory mechanics and multi-omics approaches is required. Novel patterns of pulmonary microbiota distribution in ARDS patients have emerged, with microbiota-host immune interactions significantly influencing clinical outcomes.
View Article and Find Full Text PDFEtomidate and its derivatives: time to say goodbye?
Br J Anaesth
January 2025
Universitätsmedizin Göttingen, Göttingen, Germany.
Etomidate, an intravenous hypnotic used for anaesthesia and critical care, is known for its undesirable side effects, including pain on injection, myoclonus, and adrenocortical depression. Despite its continued clinical use because of its haemodynamic stability and rapid onset and offset of effect, alternatives like propofol, ketamine, and remimazolam offer fewer drawbacks. Recent efforts to improve etomidate through chemical modifications, such as methoxyethyl etomidate hydrochloride (ET-26), have shown limited success, with persistent issues like involuntary muscle movements and adrenocortical suppression.
View Article and Find Full Text PDFUnsupervised machine learning analysis to identify patterns of ICU medication use for fluid overload prediction.
Pharmacotherapy
January 2025
Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens, Georgia, USA.
Background: Fluid overload (FO) in the intensive care unit (ICU) is common, serious, and may be preventable. Intravenous medications (including administered volume) are a primary cause for FO but are challenging to evaluate as a FO predictor given the high frequency and time-dependency of their use and other factors affecting FO. We sought to employ unsupervised machine learning methods to uncover medication administration patterns correlating with FO.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!