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Deep continuous patient-requested sedation until death: a multicentric study
  1. Adrien Serey,
  2. Colombe Tricou,
  3. Nicolas Phan-Hoang,
  4. Myriam Legenne,
  5. Élise Perceau-Chambard and
  6. Marilene Filbet
  1. Department of Palliative Care, Hospices Civils de Lyon, Lyon, France
  1. Correspondence to Professor Marilene Filbet, Department of Palliative Care, Hospices Civils de Lyon, Lyon 69495, France; marilene.filbet{at}chu-lyon.fr

Abstract

Objectives In 2016, a new law was adopted in France granting patients the right, under specific conditions, to continuous deep sedation until death (CDSUD). The goal of this study was to measure the frequency of requests for CDSUD from patients in palliative care.

Methods The data collected from the medical records of patients in palliative care units (PCU) or followed by palliative care support teams (PCST) in the Rhône-Alpes area, who died after CDSUD, focused on the patient’s characteristics, the drugs used (and compliance with regulatory processes).

Results All 12 PCU and 12 of the 24 PCST were included. Among the 8500 patients followed, 42 (0.5%) requested CDSUD until death. The patients were: 65.7 (SD=13.7) years old, highly educated (69%), had cancer (81%), refractory symptoms (98%) and mostly psychoexistential distress (69%). The request was rejected for 2 (5%) patients and delayed for 31 (74%) patients. After a delay of a mean 8 days, 13 (31%) patients were granted CDSUD. The drug used was midazolam at 115 mg/24 hours (15–480), during a mean of 3 days. PCUs used lower dosages than PCSTs (83 vs 147), with significantly lower initial doses (39 mg vs 132 mg, p=0.01). A life-threatening condition was recorded in 13 cases (31%) and a collegial decision was taken in 25 cases (60%).

Conclusion This study highlights the low rate of request and the even lower rate of CDSUD in specialised palliative care. However, the sedation for psychoexistential distress and the lack of procedure records raise ethical questions.

  • deep sedation until death
  • midazolam
  • palliative care
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Footnotes

  • Contributors MF is responsible for the overall content as guarantor. The guarantor accepts full responsibility for the work and/or the conduct of the study, had access to the data and controlled the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the investigator's institutional ethics committee. The protocol of the study was accepted by the institutional review board of our institution on 2 July 2017.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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