Nuestra experiencia en sedación paliativa como opción terapéutica en pacientes en situación clínica de últimos días

  1. Fernando Carmona-Espinazo 1
  2. Francisco Sánchez-Prieto 1
  3. Juan Bosco López-Sáez 2
  1. 1 Hospital Universitario Puerta del Mar, Cádiz
  2. 2 Hospital Universitario Puerto Real, Cádiz
Journal:
Revista española de medicina legal: órgano de la Asociación Nacional de Médicos Forenses

ISSN: 0377-4732

Year of publication: 2016

Volume: 42

Issue: 3

Pages: 93-97

Type: Article

DOI: 10.1016/J.REML.2015.12.001 DIALNET GOOGLE SCHOLAR lock_openOpen access editor

More publications in: Revista española de medicina legal: órgano de la Asociación Nacional de Médicos Forenses

Abstract

Aim To determine the frequency of palliative sedation in our unit, to know the characteristics of the patients to whom it was applied and to describe the therapeutic measures that were employed. Material and methods Observational retrospective study of all patients who were admitted and died in the Palliative Care Unit of the Puerta del Mar University Hospital (Cádiz, Spain) between January 1st 2013 and December 31st 2013. All of them were oncology patients. The data were obtained from the medical records. A descriptive analysis of all the collected variables was performed. Results A total of 290 patients were admitted; 92 died (31.7%). Among the latter, sedative treatment was applied to 25 (27.2%). About half of these were male (52.0%) and their mean age was 61.7 years (SD 10.2). The most common refractory symptom was dyspnea (36.0%). In all cases midazolam was used for sedation, alone or in combination with levomepromazine. Its route of administration was intravenous or subcutaneous. Conclusions The clinical profile of patients requiring palliative sedation was: male, of 62 years of age, oncological and with dyspnea as refractory symptom. The most employed drug was midazolam.

Bibliographic References

  • Abarshi E, Rietjens J, Caraceni A, Payne S, Deliens L, van den Block L. Towards a standardised approach for evaluating guide- lines and guidance documents on palliative sedation: study protocol. BMC Palliat Care. 2014;13:34.
  • Ahmedzai SH, Costa A, Blengini C, Bosch A, Sanz-Ortiz J, Ventafridda V, et al. A new international framework for pal- liative care. Eur J Cancer. 2004;40:2192---200.
  • Aoun SM, Kristjason LJ. Evidence in palliative care research: How should it be gathered? Med J Aust. 2005;183:264---6.
  • Azulay A, Andrés D, Huguet I. El principio de autonomía en la sedación terminal en un hospital de media y larga estancia. Med Pal. 2002;9:6.
  • Azulay Tapiero A. La sedación terminal. Aspectos éticos. An Med Interna (Madrid). 2003;20:644---9.
  • Bermejo JC, Díaz-Albo E, Sánchez E, editors. Manual básico para la atención integral en cuidados paliativos. Madrid: Cáritas Espan˜ola; 2011.
  • Bruinsma S, Rietjens J, Seymour JE, Anquinet L, van der Heide The experience of relatives with the practice of pallia- tive sedation: a systematic review. J Pain Symptom Manage. 2012;44:431---45.
  • Casas Martínez ML. Sedación terminal, eutanasia y bioética. Rev Cubana Med [revista electrónica]. 2005;44 [accessed 15 Oct 2015]: Available in: http://scielo.sld.cu/ scielo.php?pid=S0034-75232005000500013&script=sci arttext.
  • Castellano Vela E, Olmos Navarro P, Rochina Puchades A, Fort Navarro N, Navarro Sanz R. Análisis del empleo de la sedación paliativa en un hospital de atención a pacientes crónicos. Med Paliat. 2013;20:123---32.
  • Centeno Cortés C, Gómez Sancho M, Nabal Vicun˜a M, Pascual López A. Manual de medicina paliativa. Pamplona: EUNSA; 2009.
  • Definición de cuidado paliativo [página en Internet]. Madrid: Asociación Espan˜ola Contra el Cáncer; 2015 [updated 5 Aug 2015; accessed 15 Oct 2015]. Available in: https://www.aecc.es/SobreElCancer/CuidadosPaliativos/Paginas/Definicióndecuidadopaliativo.aspx.
  • Earle CC, Ayanian JZ. Looking back from death: the value of retrospective studies of end-of-life care. J Clin Oncol. 2006;24:838---40.
  • Espinar Cid V. Los cuidados paliativos: acompan˜ando a las per- sonas en el final de la vida. Cuad Bioet. 2012;23:169---76.
  • Gu X, Cheng W, Chen M, Liu M, Zhang Z. Palliative sedation for terminally ill cancer patients in a tertiary cancer center in Shanghai, China. BMC Palliat Care. 2015;14:5.
  • Hauer KE, Fernandez A, Teherani A, Boscardin CK, Saba GW. Assessment of medical students’ shared decision-making in standardized patient encounters. J Gen Intern Med. 2011;26:367---72.
  • Marchand L. Integrative and complementary therapies for patients with advanced cancer. Ann Palliat Med. 2014;3: 160---71.
  • Matoses Chirivella C, Rodríguez Lucena FJ, Sanz Tamargo G, Murcia López AC, Morante Hernández M, Navarro Ruiz A. Admin- istración de medicamentos por vía subcutánea en cuidados paliativos. Farm Hosp. 2015;39:71---9.
  • McKinnon M, Azevedo C, Bush SH, Lawlor P, Pereira J. Practice and documentation of palliative sedation: a quality improve- ment initiative. Curr Oncol. 2014;21:100---3.
  • Mercadante S, Porzio G, Valle A, Fusco F, Aielli F, Costanzo V, et al. Palliative sedation in patients with advanced cancer fol- lowed at home: a systematic review. J Pain Symptom Manage.2011;41:754---60.
  • Nabal M, Palomar C, Juvero MT, Taberner MT, León M, SaludSedación paliativa: situación actual y áreas de mejora. Rev Calid Asist. 2014;29:104---11.
  • Olsen ML, Swetz KM, Mueller PS. Ethical decision making with end-of-life care: palliative sedation and withholding or withdrawing life-sustaining treatments. Mayo Clin Proc. 2010;85:949---54.
  • Organización Médica Colegial (OMC). Sociedad Espan˜ola de Cuidados Paliativos (SECPAL). Guía de sedación paliativa. Cuad Bioet. 2011;22:605---12.
  • Pérez Bret E. La excelencia de los cuidados paliativos. Cuad Bioet. 2011;22:535---41.
  • Reville B, Foxwell AM. The global state of palliative care- progress and challenges in cancer care. Ann Palliat Med. 2014;3:129---38.
  • Sánchez-Román S, Beltrán Zavala C, Lara Solares A, Chiquete E. Delirium en adultos que reciben cuidados paliativos: revisión de la literatura con un enfoque sistemático. Rev Psiquiatr Salud Ment (Barc). 2014;7:48---58.
  • Sanz Ortiz J. La sedación en el final de la vida. Med Clin (Barc). 2004;123:423---5.
  • Savory EA, Marco CA. End-of-life issues in the acute and crit- ically ill patient. Scand J Trauma Resusc Emerg Med. 2009;17: 21.
  • Sinuff T, Dodek P, You JJ, Barwich D, Tayler C, Downar J, et al. Improving end-of-life communication and decision making: the development of a conceptual framework and quality indicators. J Pain Symptom Manage. 2015;49:1070---80.
  • Vilches Aguirre Y, González Barón M, Calvo Elipe A. Cuidados en la agonía, síntomas refractarios y sedación. In: González Barón M, Ordón˜ez A, Feliu J, Zamora P, Espinosa E, editors. Tratado de medicina paliativa y tratamiento del paciente con cáncer. 2nd ed. Buenos Aires: Panamericana; 2007. p. 799---809.
  • Voeuk A, Oneschuk D. Continuous palliative sedation therapy. Can Fam Physician. 2014;60:813---5.
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