• Lenzo Robijn, Luc Deliens, Anne-Lore Scherrens, Nele S Pauwels, Peter Pype, Judith Rietjens, and Kenneth Chambaere.
• Vrije Universiteit Brussel (VUB) & Ghent University, End-of-Life Care Research Group, Brussels, Belgium.
• Palliat Med. 2021 Apr 1; 35 (4): 670-682.

BackgroundExtensive debate surrounds the practice of continuous sedation until death within end-of-life care.AimTo provide insight into existing initiatives to support the practice of continuous sedation until death and assess their feasibility and effectiveness.DesignSystematic review and narrative synthesis, registered on PROSPERO (CRD42020149630).Data SourcesRecords were searched through MEDLINE, EMBASE, CENTRAL, CINAHL, and Web of Science from inception to April 16 2020. Peer-reviewed studies reporting original data on initiatives to support the practice of continuous sedation were included for review.ResultsTwenty-one studies met the criteria and were included. Initiatives were focused on assessment tools of consciousness and discomfort (9), the use of guidelines and protocols (8), and expert consultation (3). All initiatives were reported as useful, acceptable, and feasible. Studies on the use of monitoring devices showed that a small proportion of patients were found to be awake, despite the patient being unresponsive according to the observer-based sedation scales. However, the wide range of values of these monitoring devices for comfortable and adequately sedated patients seems to hamper its overall implementation in daily clinical practice. Physicians reported changes in practice conform to guideline recommendations but the shift was modest at best. Expert consultation was regarded as supportive when sufficient expertise is lacking and helpful in avoiding possibly unnecessary sedations.ConclusionsThe reviewed initiatives may contribute to improvement of continuous sedation until death, though their evidence base is rather limited. More insight is needed into their feasibility, preconditions for effective implementation and impact in actual practice.

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