Efficacy of proportional sedation and deep sedation defined by sedation protocols : a multicenter, prospective, observational comparative study: protocol-based palliative sedation

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IMAI, Kengo | MORITA, Tatsuya | YOKOMICHI, Naosuke | KAWAGUCHI, Takashi | KOHARA, Hiroyuki | YAMAGUCHI, Takashi | KIKUCHI, Ayako | ODAGIRI, Takuya | WATANABE, Yuki Sumazaki | KAMURA, Rena | MAEDA, Isseki | KAWASHIMA, Natsuki | ITO, Satoko | BABA, Mika | MATSUDA, Yosuke | OYA, Kiyofumi | KANEISHI, Keisuke | HIRATSUKA, Yusuke | NAITO, Akemi Shirado | MORI, Masanori

Purpose: To investigate the efficacy of two types of palliative sedation: proportional and deep sedation, defined by sedation protocols. Methods: From a multicenter prospective observational study, we analyzed the data of those patients who received the continuous infusion of midazolam according to the sedation protocol. The primary endpoint was goal achievement at 4 hours: in proportional sedation, symptom relief (Integrated Palliative care Outcome Scale: IPOS=1) and absence of agitation (modified Richmond Agitation-Sedation Scale: RASS=0); in deep sedation, the achievement of deep sedation (RASS=-4). Secondary endpoints included deep sedation as a result of proportional sedation, communication capacity (Communication Capacity Scale item4=2), IPOS and RASS scores, and adverse events. Results: A total of 81 patients from 14 palliative care units were analyzed: proportional sedation (n=64) and deep sedation (n=17). At 4 hours, the goal was achieved in 77% (n=49; 95% confidence interval: 66-87) with proportional sedation; and 88% (n=15; 71-100) with deep sedation. Deep sedation was necessary in 45% of those who received proportional sedation. Communication capacity was maintained in 34% with proportional sedation and 10% with deep sedation. IPOS decreased from 3.5 to 0.9 with proportional sedation, and 3.5 to 0.4 with deep sedation; RASS decreased from +0.3 to -2.6, and +0.4 to -4.2, respectively. Fatal events related to the treatment occurred in 2% (n=1) with proportional and none with deep sedation. Conclusion: Proportional sedation achieved satisfactory symptom relief while maintaining some patients’ consciousness, and deep sedation achieved good symptom relief while the majority of patients lost consciousness.

http://dx.doi.org/10.1016/j.jpainsymman.2021.06.005

Voir la revue «JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 62»

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