• Nathalie Dieudonné Rahm, Ghizlaine Morawska, Sophie Pautex, and Nadia Elia.
• Division of Palliative Medicine, Department of Geriatrics and Rehabilitation, Geneva University Hospitals, Hôpital de Bellerive, Collonge-Bellerive, Geneva, Switzerland.
• Palliat Med. 2021 Sep 1; 35 (8): 1407-1420.

BackgroundProviding unawareness and pain relief are core elements of palliative sedation. In addition to clinical scales, nociception and electroencephalogram-based depth of sedation monitoring are used to assess the level of consciousness and analgesia during sedation in intensive care units and during procedures.AimTo determine whether reported devices impact the outcomes of palliative sedation.DesignSystematic review and narrative synthesis of research published between January 2000 and December 2020.Data SourcesEmbase, Google Scholar, PubMed, CENTRAL, and the Cochrane Library. All reports describing the use of any monitoring device to assess the level of consciousness or analgesia during palliative sedation were screened for inclusion. Data concerning safety and efficacy were extracted. Patient comfort was the primary outcome of interest. Articles reporting sedation but that did not meet guidelines of the European Association for Palliative Care were excluded.ResultsSix reports of five studies were identified. Four of these were case series and two were case reports. Together, these six reports involved a total of 67 sedated adults. Methodological quality was assessed fair to good. Medication regimens were adjusted to bispectral index monitoring values in two studies, which found poor correlation between monitoring values and observational scores. In another study, high nociception index values, representing absence of pain, were used to detect opioid overdosing. Relatives and caregivers found the procedures feasible and acceptable.

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