Read by QxMD icon Read

Palliative Sedation

Tatsuya Morita, Kengo Imai, Naosuke Yokomichi, Masanori Mori, Yoshiyuki Kizawa, Satoru Tsuneto
Continuous deep sedation until death (CDS) is a type of palliative sedation therapy, and it has recently become a focus of intense debate. Marked inconsistencies in intervention procedures (i.e., what is CDS?) and unstandardized descriptions of patient backgrounds lead to difficulty in comparing the results in the literature. The primary aim of this paper was to propose a conceptual framework to perform empirical studies on CDS. We propose the definition of CDS using the intervention protocol. As there are two types of CDS proposed in world-wide literature, we recommend to prepare two types of intervention protocol for CDS: "continuous deep sedation as a result of proportional sedation" (gradual CDS), and "continuous deep sedation to rapidly induce unconsciousness" (rapid CDS)...
October 13, 2016: Journal of Pain and Symptom Management
Tammy Vu Bach, Jonathan Pan, Anne Kirstein, Cindy Joanne Grief, Daphna Grossman
Palliative care clinicians are increasingly involved in the care of elderly patients suffering from chronic malignant and nonmalignant illnesses, of which neuropathic pain is a prevalent problem. As a person becomes more frail, pain medications such as opioid analgesics and adjuvant pain medications can result in unwanted effects such as sedation, confusion, and increased risk of falls. Treating pain in patients with advanced dementia or neurodegenerative diseases that can affect swallowing is particularly challenging because most adjuvant pain medications used to ameliorate neuropathic pain must be taken orally...
October 11, 2016: Journal of Palliative Medicine
Jennifer B Seaman, Amber E Barnato, Susan M Sereika, Mary Beth Happ, Judith A Erlen
OBJECTIVE: Describe patterns of palliative care service consultation among a sample of ICU patients at high risk of dying. BACKGROUND: Patients receiving mechanical ventilation (MV) face threats to comfort, social connectedness and dignity due to pain, heavy sedation and physical restraint. Palliative care consultation services may mitigate poor outcomes. METHODS: From a dataset of 1440 ICU patients with ≥2 days of MV and ≥12 h of sustained wakefulness, we identified those at high risk of dying and/or who died and assessed patterns of sub-specialty palliative care consultation...
October 4, 2016: Heart & Lung: the Journal of Critical Care
Jean François Ciais, Flora Tremellat, Maud Castelli-Prieto, Caroline Jestin
BACKGROUND: At the end of life, patients may feel refractory pain during care procedures although they receive appropriate analgesia. They can benefit from a short-term sedation. Propofol is used for procedural sedation in emergency or reanimation departments. It may be adapted in a palliative care unit. OBJECTIVE: The main objective was to verify whether propofol could allow us to administer care without causing major pain to patients with refractory pain at the end of life...
September 27, 2016: Journal of Palliative Medicine
Sandra Martins Pereira, Carla Margarida Teixeira, Ana Sofia Carvalho, Pablo Hernández-Marrero
INTRODUCTION: Professionals working in intensive and palliative care units, hence caring for patients at the end-of-life, are at risk of developing burnout. Workplace conditions are determinant factors to develop this syndrome among professionals providing end-of-life care. OBJECTIVES: To identify and compare burnout levels between professionals working in intensive and palliative care units; and to assess which workplace experiences are associated with burnout...
2016: PloS One
Adam Wheeler, Dan Vu, Pierangelo Renella
We present a case of an ex-30 week premature male infant diagnosed postnatally with Tetralogy of Fallot, hemitruncus, and discontinuous pulmonary arteries (PAs) at 6 days of life. The patient was diagnosed by echocardiography, and the diagnosis was confirmed on subsequent dual-energy chest CT angiogram. In our patient, the left PA arose directly from the aorta, whereas the right PA originated normally from the right ventricular outflow tract. At 9 days of life, he underwent successful surgical palliation with placement of a modified Blalock-Taussig (aortopulmonary) shunt from the base of the left subclavian artery to the anomalously connected left PA along with anastomosis together of the right and left branch PAs to establish continuity with the main PA...
September 2016: Radiology case reports
Cis Vrijmoeth, Milou G M Christians, Dederieke A M Festen, Marieke Groot, Agnes van der Heide, Carin C D van der Rijt, Marijke Tonino, Michael A Echteld
BACKGROUND: Insights into symptoms and interventions at the end of life are needed for providing adequate palliative care, but are largely lacking for people with intellectual disabilities (IDs). OBJECTIVES: We aimed at determining the prevalence rates of physician-reported symptoms from the Edmonton Symptom Assessment System (ESAS) at the moment that physicians recognized patient's death in the foreseeable future. In addition, we aimed at exploring provided interventions as reported by physicians in the period between physicians' recognition of death in the foreseeable future and patients' death...
September 1, 2016: Journal of Palliative Medicine
Ryo Matsunuma, Hazuki Takato, Yoshihiro Takeda, Satoshi Watanabe, Yuko Waseda, Shinya Murakami, Yukimitsu Kawaura, Kazuo Kasahara
INTRODUCTION: Patients with end-stage interstitial  lung disease (ILD) do not appear to receive adequate palliative care despite apparent suffering before death. The aim of this study was to evaluate their signs, symptoms, and treatment received before death. METHODS: Patients with ILD and lung cancer (LC) who were hospitalized and died in our hospital were enrolled retrospectively. Signs and symptoms and treatments at 7 days, 3 days, and 1 day before death were evaluated and compared between the two groups of patients...
July 2016: Indian Journal of Palliative Care
Dagmar Kettemann, Andreas Funke, André Maier, Simone Rosseau, Robert Meyer, Susanne Spittel, Christoph Münch, Thomas Meyer
Non-invasive ventilation (NIV) or tracheotomy with invasive ventilation (TIV) are treatment options in ALS. However, a proportion of patients receiving long-term ventilation decide to have it withdrawn. The objective of this study was to analyse the clinical characteristics and palliative approaches in ALS patients withdrawing from long-term ventilation (WLTV). In a cohort study, two different palliative concepts in WLTV were studied: (1) augmented symptom control (ASC; sedation not intended) in patients with ventilator-free tolerance; (2) continuous deep sedation (CDS; sedation intended) in patients without ventilator-free tolerance...
August 18, 2016: Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration
Barton Bobb
Palliative sedation has become a standard practice to treat refractory symptoms at end-of-life. Dyspnea and delirium are the two most commonly treated symptoms. The medications used in palliative sedation are usually benzodiazepines, barbiturates, antipsychotics, and/or anesthetics. Some ethical considerations remain, especially surrounding the use of palliative sedation in psychological distress and existential suffering.
September 2016: Nursing Clinics of North America
Kazuki Sato, Mitsunori Miyashita, Tatsuya Morita, Satoru Tsuneto, Yasuo Shima
BACKGROUND: Comprehensive information on end-of-life care in specialized palliative care settings is needed to assess the quality of care. OBJECTIVE: This study aimed to investigate medical treatments in the last two weeks of life in a national sample of palliative care units in Japan. DESIGN: Retrospective cohort study. SETTING/SUBJECTS: Medical charts of 2802 consecutive cancer patients who died in 37 palliative care units were reviewed...
July 27, 2016: Journal of Palliative Medicine
A Zamora-Mur, R García-Foncillas, A Zamora-Catevilla, M Nabal-Vicuña, V Calderero-Aragón, F Lostalé-Latorre
INTRODUCTION: Sedation, used as a therapeutic measure in the field of Palliative Care, continues to present difficulties for many professionals in its management and indications. Is varied existing literature in this regard, often exclusive cancer patients. Our objective is to analyse the characteristics of patients attended by a Home Care Support Team who required sedation compared to non-sedated patients, for possible determining factors for its use that could help in decision-making...
July 18, 2016: Semergen
Larry D Cripe, Susan M Perkins, Ann Cottingham, Yan Tong, Mary Ann Kozak, Rakesh Mehta
INTRODUCTION: Palliative sedation for refractory existential distress (PS-ED) is ethically troubling but potentially critical to quality end-of-life (EOL) care. Physicians' in postgraduate training support toward PS-ED is unknown nor is it known how empathy, hope, optimism, or intrinsic religious motivation (IRM) affect their support. These knowledge gaps hinder efforts to support physicians who struggle with patients' EOL care preferences. METHODS: One hundred thirty-four postgraduate physicians rated their support of PS for refractory physical pain (PS-PP) or PS-ED, ranked the importance of patient preferences in ethically challenging situations, and completed measures of empathy, hope, optimism, and IRM...
July 18, 2016: American Journal of Hospice & Palliative Care
Rogier H P D van Deijck, Jeroen G J Hasselaar, Stans C A H H V M Verhagen, Kris C P Vissers, Raymond T C M Koopmans
CONTEXT: A gold standard or validated tool for monitoring the level of discomfort during continuous palliative sedation (CPS) is lacking. Therefore, little is known about the course of discomfort in sedated patients, the efficacy of CPS, and the determinants of discomfort during CPS. OBJECTIVES: To identify the course of discomfort in patients receiving CPS. METHODS: A prospective observational multicenter study in nine hospices and palliative care units was performed...
September 2016: Journal of Pain and Symptom Management
Blair Henry
PURPOSE OF REVIEW: Palliative sedation has been the subject of intensive debate since its first appearance in 1990. In a 2010 review of palliative sedation, the following areas were identified as lacking in consensus: inconsistent terminology, its use in nonphysical suffering, the ongoing experience of distress, and concern that the practice of palliative sedation may hasten death. This review looks at the literature over the past 6 years and provides an update on these outstanding concerns...
September 2016: Current Opinion in Supportive and Palliative Care
P Stachura, J Berendt, S Stiel, U S Schuler, C Ostgathe
BACKGROUND: Standard operating procedures (SOPs) can contribute to the improvement of patient care. OBJECTIVES: Survey the presence and relevance of SOPs for palliative care (PC) within the network of German Comprehensive Cancer Centers (CCCs) funded by the German Cancer Aid. MATERIALS AND METHODS: In a descriptive survey, palliative care services within 15 CCCs funded by the German Cancer Aid were asked to rate availability and thematic relevance of (1) symptom-related, (2) clinical pathways and (3) measures- and processes-oriented SOPs using a structured questionnaire...
June 27, 2016: Der Schmerz
Lenzo Robijn, Joachim Cohen, Judith Rietjens, Luc Deliens, Kenneth Chambaere
BACKGROUND: Continuous deep sedation until death is a highly debated medical practice, particularly regarding its potential to hasten death and its proper use in end-of-life care. A thorough analysis of important trends in this practice is needed to identify potentially problematic developments. This study aims to examine trends in the prevalence and practice characteristics of continuous deep sedation until death in Flanders, Belgium between 2007 and 2013, and to study variation on physicians' degree of palliative training...
2016: PloS One
Kay De Vries, Marek Plaskota
OBJECTIVE: Palliative sedation is a method of symptom management frequently used in hospices to treat uncontrolled symptoms at the end of life. There is a substantial body of literature on this subject; however, there has been little research into the experiences of hospice nurses when administering palliative sedation in an attempt to manage the terminal restlessness experienced by cancer patients. METHOD: Semistructured interviews were conducted with a purposive sample of seven hospice nurses who had cared for at least one patient who had undergone palliative sedation within the past year in a hospice in the south of England in the United Kingdom...
June 21, 2016: Palliative & Supportive Care
Tsukasa Higuchi, Kazuhiro Shimada, Yoshiaki Cho, Kisei Minami, Kouichi Takeuchi, Akiyuki Sakamoto
Although the effectiveness of subarachnoid continuous drug infusion has been established in cancer pain management, its clinical use in children is rare. A 14-year-old girl with neurofibromatosis type I complained of right leg pain stemming from a growing tumor on her right buttock. Continuous and breakthrough right leg pain were unbearable, even at high doses of systemic opioids that caused severe constipation and deep sedation. Subsequent continuous infusion of bupivacaine and morphine through a subarachnoid catheter effectively relieved the girl's pain...
August 2016: Pediatrics International: Official Journal of the Japan Pediatric Society
Anniek D Masman, Monique van Dijk, Joost van Rosmalen, Heleen J Blussé van Oud-Alblas, Erwin Ista, Frans P M Baar, Dick Tibboel
CONTEXT: If regular therapies cannot relieve symptoms sufficiently in the last days of life, continuous palliative sedation may serve to reduce consciousness. Sedation level can be measured with EEG monitoring with the bispectral index (BIS) monitor. OBJECTIVES: To determine the feasibility and validity of BIS monitoring in terminally ill patients. METHODS: In this prospective study, BIS registrations were performed in unconscious end-of-life patients admitted to a palliative care center...
August 2016: Journal of Pain and Symptom Management
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"