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Efficacy of two types of palliative sedation therapy defined using intervention protocols : proportional vs. deep sedation
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PURPOSE: This study investigated the effect of two types of palliative sedation defined using intervention protocols: proportional and deep sedation.
METHODS: We retrospectively analyzed prospectively recorded data of consecutive cancer patients who received the continuous infusion of midazolam in a palliative care unit. Attending physicians chose the sedation protocol based on each patient’s wish, symptom severity, prognosis, and refractoriness of suffering. The primary endpoint was a treatment goal achievement at 4 h: in proportional sedation, the achievement of symptom relief (Support Team Assessment Schedule (STAS) = 1) and absence of agitation (modified Richmond Agitation-Sedation Scale (RASS) = 0) and in deep sedation, the achievement of deep sedation (RASS = - 4). Secondary endpoints included mean scores of STAS and RASS, deep sedation as a result, and adverse events.
Results:
Among 398 patients who died during the period, 32 received proportional and 18 received deep sedation. The treatment goal achievement rate was 68.8% (22/32, 95% confidence interval 52.7–84.9) in the proportional sedation group vs. 83.3% (15/18, 66.1–100) in the deep sedation group. STAS decreased from 3.8 to 0.8 with proportional sedation at 4 h vs. 3.7 to 0.3 with deep sedation; RASS decreased from + 1.2 to - 1.7 vs. + 1.4 to - 3.7, respectively. Deep sedation was needed as a result in 31.3% (10/32) of the proportional sedation group. No fatal events that were considered as probably or definitely related to the intervention occurred.
CONCLUSION: The two types of intervention protocol well reflected the treatment intention and expected outcomes. Further, large-scale cohort studies are promising.
http://dx.doi.org/10.1007/s00520-017-4011-2
Voir la revue «Supportive care in cancer»
Autres numéros de la revue «Supportive care in cancer»
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