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Characteristics of adequate outcome of continuous palliative sedation
  1. S Buma1,
  2. T Brinkkemper1,2,
  3. S J Swart3,
  4. J A C Rietjens3,
  5. L Deliens2,
  6. M Ribbe2,
  7. S A Loer1,
  8. W W A Zuurmond1,4 and
  9. R S G M Perez1,2,4
  1. 1VU University Medical Center, Amsterdam, The Netherlands
  2. 2EMGO+ institute, Amsterdam, The Netherlands
  3. 3Erasmus Medical Center, Rotterdam, The Netherlands
  4. 4Hospice Kuria, Amsterdam, The Netherlands

Abstract

Introduction and aims Palliative sedation is a palliative care intervention for relieving severe suffering in the last phase of life. This study aims to distinguish characteristics of adequate sedation outcome compared to less favourable outcome based on physicians' reports.

Methods In 2008, a structured questionnaire was sent to a random sample of 1580 physicians working in general practice, nursing homes and hospitals regarding their last patient receiving continuous sedation until death. Adequate outcome was defined as cases where adequate relief of symptoms, good to very good quality of death and no adverse reactions were reported by the physician.

Results A total of 606 physicians (38%) filled out the questionnaire, of whom 370 (61%) reported about their last case of continuous deep sedation. Cases characterised as adequate outcome (n=110) significantly more often had nausea (16% vs 7%), but less often delirium (7% vs 15%) as decisive indication for palliative sedation. Significantly more often, cases defined as adequate were sedated with the (partial) intention of hastening death (19% vs 13%), exhibited a shorter median duration of sedation (32 (IQR 16–48) versus 48 (IQR 24–73) h), had a shorter median duration to reach the required sedation depth (2 (IQR 1–4) versus 4 (IQR 2–12), were more often sedated deeper (94% vs 84%) and received a stable administration of benzodiazepines and opioids (52% vs 26%).

Conclusion Differences between perceived adequate and less adequate sedation outcome may be related to intention and mode of administration of palliative sedation.

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