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Deep continuous sedation at the patient’s request until death in a palliative care unit: retrospective study
  1. Simon Prampart1,
  2. Jean Francois Huon2,3,
  3. Andre Colpaert1,
  4. Clémence Delavaud1,
  5. Julien Nizard1,4 and
  6. Adrien Evin1,3
  1. 1CHU de Nantes, Service de Soins Palliatifs et de Support, Nantes Université, Nantes, France
  2. 2CHU de Nantes, Pharmacie, Nantes Université, Nantes, France
  3. 3INSERM UMR 1246 SPHERE, Nantes Université, Nantes, France
  4. 4EA4391 Therapeutic and Nervous Excitability, Universite Paris-Est Creteil Val de Marne, Creteil, France
  1. Correspondence to Dr Adrien Evin, CHU de Nantes, Service de Soins Palliatifs et de Support, Nantes Université, Nantes, F-44000, France; adrien.evin{at}chu-nantes.fr

Abstract

Objectives Limited descriptive data are available on continuous and deep sedation maintained until death (CDSUD) at the patient’s request in palliative care units. This study aimed to describe such practices in the context of refractory suffering or after a request to stop life-sustaining treatment, evaluating the duration and dosage of sedative treatments used.

Methods This retrospective observational study included consecutively hospitalised patients in a palliative care unit from January 2020 to December 2021. Data on patient profiles, reasons for the sedation request, duration of sedation and doses of sedatives were collected.

Results Among 42 patients who underwent CDSUD, 79% occurred due to refractory suffering. In cases of sedation following a request to stop life support, high-dose corticosteroid therapy was the most commonly involved life-sustaining treatment. Midazolam was always the first-line sedative treatment. Chlorpromazine was added in 79% of cases, and propofol in 40%, to achieve a deep level of sedation. The mean maximum doses of midazolam, chlorpromazine and propofol were 7.6 mg/hour (±1.9), 3.3 mg/hour (±0.9) and 1.7 mg/kg/hour, respectively. The average duration of sedation was 37 hours.

Conclusions This study provides new descriptive elements on CDSUD. Notably, it highlights the use of second-line sedative molecules, such as propofol.

http://dx.doi.org/10.1136/spcare-2023-004551

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    Footnotes

    • Contributors SP and AE were responsible for study design, data analysis and manuscript preparation. JN, AC, CD and JFH assisted in manuscript preparation. AE acts as the guarantor and accepts full responsibility for the work and 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.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.