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J Pain Symptom Manage · Feb 2020
Multicenter Study Observational StudyPalliative sedation in patients hospitalized in internal medicine departments.
- Jesús Díez-Manglano, Isasi de Isasmendi PérezSoledadSInternal Medicine Department, Hospital Royo Villanova, Zaragoza, Spain., García FenollRosaRInternal Medicine Department, Hospital Miguel Servet, Zaragoza, Spain., Luis Ángel Sánchez, Françesc Formiga, Vicente Giner Galvañ, Carlos Dueñas, Bernardino Roca, Estrada DíazCristinaCInternal Medicine Department, Hospital Universitario Mutua de Tarrassa, Tarrassa, Spain., Casariego ValesEmilioEInternal Medicine Department, Hospital Lucus Augusti, Lugo, Spain., and UDMIVI study researchers.
- Internal Medicine Department, Hospital Royo Villanova, Zaragoza, Spain. Electronic address: jdiez@aragon.es.
- J Pain Symptom Manage. 2020 Feb 1; 59 (2): 302-309.
ContextPalliative sedation is used to relieve end-of-life refractory symptoms.ObjectiveThe objective of this study was to describe the use of palliative sedation in patients who die in internal medicine departments.MethodsAn 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.ResultsWe included 1447 patients, and palliative sedation was administered to 701 patients (48.4%). Having a terminal illness (odds ratio [OR] 2.469, 95% CI 1.971-3.093, P < 0.001) and the length of 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, whereas dyspnea was more common in those without cancer. Rescue doses were used 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).ConclusionsPalliative sedation is used more often for terminal patients. There are differences in the administration of palliative sedation between patients with and without cancer.Copyright © 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
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