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Palliative Sedation in Patients Hospitalized in Internal Medicine Departments

2019; Elsevier BV; Volume: 59; Issue: 2 Linguagem: Inglês

10.1016/j.jpainsymman.2019.10.013

1873-6513

Jesús Díez‐Manglano, S. Isasi de Isasmendi Pérez, Rosa García Fenoll, Luis A. Sánchez, Françesc Formiga, V. Giner, Carlos Dueñas, Bernardino Roca, Cristina Estrada Díaz, Emilio Casariego Vales, Jesús Díez‐Manglano, S. Isasi de Isasmendi Pérez, Marta Rubio Gómez, Magdalena Martín Pérez, Diez García F, Ignacio Vallejo Maroto, Cristina Ocaña Losada, Susana Moya Roldán, Catalina Díaz Pérez, Francisco J. Caballero, Resfa María García Font, Francisco J. Jódar Lorente, Gloria Pérez Vázquez, A. Expósito, María Luisa Amaya González, Fernando Gamboa, Álvaro González Molina, Mercedes Hernández, Marcos Guzmán García, Lola Benítez León, Lorena Montero Rivas, María Ruiz Mariscal, Noelia Gómez Aguirre, Maria Pilar González García, Isabel Martín Algora, María Carmen Bueno Castel, F. Ruiz Laiglesia, Esperanza Bejarano Tello, José Luis Cabrerizo García, Nuria Guiral Fernández, Luis Alberto Cámera, Carla Gauna, Pedro Abad Requejo, Rocío Martínez Gutiérrez, Rebeca Fernández Regueiro, María Teresa Sánchez Vidal, Joaquín Alfonso Mejido, Enrique García Carús, Carmen Elena Calvo Rodríguez, Paula Martínez García, Sixto Ruiz Olivares, Maria Isabel Fullana Barceló, C. González Arencibia, Rosa Ros Vilamajó, María José Monedero Prieto, Concepción González Becerra, Sofía Pérez, Andrea Martín Plata, Raquel Portilla Chocarro, Carlos Dueñas Gutiérrez, Francisco Estrada Álvarez, Sonia Peña Balbuena, Raúl Rodríguez Galindo, Marta María Cobos Siles, Luis Ángel Sánchez Muñoz, Ana Castañón López, Celia Sanz Lobo, María Montserrat Chimeno Viñas, María Ángeles Contreras Uriel, Judit Gil Domínguez, F. Medrano González, J.M. Machín Lázaro, Jeffrey Óskar Magallanes Gamboa, Mónica Rodríguez Galdeano, Joaquín Castro Giménez, José Ramón Barberá Farré, Raquel Núñez Aragón, Ferrán Masanés, José Barbé, Elena Güell Farré, Olga H. Torres, Ana lozano Miñana, Desirée Moras Sarabia, Rosa Pérez, Dolors Arnau i Fernández, Françesc Formiga, Javier Fernández, Antoni Castro, Rami Qanneta, María Victoria Pardo Ortega, Cristina Estrada Díaz, Yasmina Monterroso Pintado, Montserrat García Cors, María Cruz Almendros Rivas, Dolors Domingo Albin, Jaume Roig Morera, Nuria Galofré Álvaro, Aythami Toro Parodi, Mario Loureiro Sánchez, Carla de la Guerra Acebal, Javier Zubizarreta García, Iasone Benavente Claveras, Juan Martí Cabanes, Ignacio Sanz Lázaro, José Barquero Romero, Leticia Nevado López-Alegría, José Carlos Arévalo‐Lorido, Emilio Casariego Vales, Ana María Lorenzo Vizcaya, Cristina Macía Rodríguez, Sílvia Pérez-Fernández, Pascual Sesma Sánchez, María Dolores Jiménez-Beatty, Laura González Vázquez, Ángel Brea Hernando, Jesús Castiella Herrero, María Isabel González Anglada, Virginia M. Gracia Lorenzo, Antonia Pérez-Martín, Gerardo García Melcón, María Gómez Antúnez, María Angustias Quesada Simón, Fuensanta Gil Gil, María Asenjo Martínez, Lourdes Mancebo Aragoneses, Jorge Calderón‐Parra, María del Carmen Romero Pérez, José Curbelo, Fernando Laguna Cuesta, María Eugenia Segovia Abad, María Fontecha Ortega, Guillermina Lara Martínez, Ana Pinos Blanco, Raquel Rodil Fraile, Elisabel Martínez Litago, Aitziber Echeverría Echeverría, Manuel Valladares, Carlos Trescolí Serrano, Josep Vicente Mas, Óscar Torregrosa Suau, Eva Gil Tomás, Rafael Castillo Rubio, José Manuel Murcia Zaragoza, Pilar Román Sánchez, Ana García Herola, Pedro Pablo Tenllado Doblas, Julio César Blázquez Encinar, Enrique Castellano Vela, Néstor Carrizo, V. Giner, Bernardino Manuel Roca Villanueva, Francisco Pasquau Liaño, José María Pascual Izuel,

Healthcare Decision-Making and Restraints

Context: Palliative sedation is used to relieve end-of-life refractory symptoms.Objective: To describe the use of palliative sedation in patients who die in internal medicine departments.Methods: An observational, cross-sectional, retrospective and multicenter, clinical audit study was conducted in 145 hospitals in Spain and Argentina.Each hospital included the first 10 patients who died in the internal medicine department, starting on December 1, 2015. Results:We included 1447 patients, and palliative sedation was administered to 701 (48.4%).Having a terminal illness (OR 2.469, 95%CI 1.971-3.093,p<0.001) and the length of the hospital stay (OR 1.011, 95%CI 1.002-1.021,p=0.017) were independently associated with the use of palliative sedation.Consent was granted by the families of 582 (83%) patients.The most common refractory symptom was dyspnea, and the most commonly used drugs for sedation were midazolam (77%) and morphine (89.7%).An induction dose was administered in 25.7% of the patients.Rescue doses were scheduled for 70% of the patients, and hydration was maintained in 49.5%.Pain was more common in patients with cancer, while dyspnea was more common in those without cancer.Rescue doses were employed more often for the patients with cancer (77.8% vs. 67.7%,p=0.015).Monitoring the palliative sedation with a scale was more frequent in the patients with cancer (23.7% vs. 14.3%, p=0.008).Conclusions: Palliative sedation is employed more often for terminal patients.There are differences in the administration of palliative sedation between patients with and without cancer. KEY MESSAGEThis multicenter observation study describes the use of palliative sedation in patients who die in internal medicine departments.The most common refractory symptom was pain in patients with cancer and dyspnea in those without cancer.Rescue doses were employed more often for patients with cancer.