Descriptive analysis of palliative sedation in a pediatric palliative care unit

Noriega, Íñigo de; Andrés, Manuel Rigal; Alba, Ricardo Martino

doi:10.1016/j.anpede.2022.04.004

Cited by 5 publications

(8 citation statements)

References 21 publications

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“…Palliative sedation may be necessary when symptoms are refractory to treatment. In our study, relative frequency of palliative sedation was slightly higher than in other study performed in Spain (17.6% vs. 12.3%) 23 . This difference could be because it was carried out in a PC department, where they may have greater experience in end‐of‐life symptom control and in palliative sedation.…”

Section: Discussioncontrasting

confidence: 77%

“…In our study, relative frequency of palliative sedation was slightly higher than in other study performed in Spain (17.6% vs. 12.3%). 23 This difference could be because it was carried out in a PC department, where they may have greater experience in end-of-life symptom control and in palliative sedation. Moreover, when professionals have a better understanding of the patient and the family, they can tailor care to the patient's individual needs.…”

Section: Discussionmentioning

confidence: 99%

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How do hospitalised children die? The context of death and end‐of‐life decision‐making

Serrano-Pejenaute

Carmona-Nunez

Zorrilla-Sarriegui

et al. 2023

J Paediatrics Child Health

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Aim The decrease in childhood mortality, the growing clinical complexity and the greater technification of intensive care units have changed the circumstances of death of paediatric patients. The aim of this study is to describe the context of death and end‐of‐life decision‐making. Methods Single‐centre, retrospective, observational study of deaths in inpatients or home hospitalised children under 18 years old between 2011 and 2021. Demographic data, pathological history and circumstances of death were obtained from the medical record. The whole study period was divided into two halves for the analysis of the temporal trends. Results A total of 358 patients died, 63.2% under the age of 1 year old; 86.9% had underlying life‐limiting illnesses and 73.2% died in the intensive care unit, with no differences between the two time periods. Death at home was significantly higher in the second study period (3.8% vs. 9%). A total of 20.1% died during advanced cardiopulmonary resuscitation. Life‐sustaining treatment was withheld or withdrawn in 53.6%, with no differences between the time courses. Life‐sustaining treatment was withheld mainly in patients with neurological, metabolic and oncological conditions, and less frequently in patients with cardiovascular or respiratory diseases or who were previously healthy. Most patients coded as palliative care (PC) or followed up by PC teams had an advance care plan (ACP) recorded, while in the others it was infrequent. PC coding, following by PC teams and ACP recording increased in the last years of the study. Conclusions Death of children in our setting usually occurs in relation to complex underlying pathology and after the decision of withdrawing or withholding life‐sustaining treatment. In this context, PC and ACP acquire greater importance. In our study, PC involvement resulted in better documentation of ACP and PC coding.

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Section: Discussioncontrasting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

How do hospitalised children die? The context of death and end‐of‐life decision‐making

Serrano-Pejenaute

Carmona-Nunez

Zorrilla-Sarriegui

et al. 2023

J Paediatrics Child Health

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“…33 The lack of consensus among clinicians leads to significant variation in PST practices, which may be improved by efforts towards standardization of care. One of the most notable variations is the PST medication selection, ranging from benzodiazepines and opioids, which remain prominent in current practice, [34][35][36][37][38] to propofol and dexmedetomidine, which are used less frequently. 19,26,[28][29][30] Guidelines for medication selection and PST implementation are needed to improve the utilization of pediatric PST and reduce suffering at EOL.…”

Section: Introductionmentioning

confidence: 99%

Palliative Sedation Therapy Practice Comparison – A Survey of Pediatric Palliative Care and Pain Management Specialists

Cuviello

Ang

Morgan

et al. 2022

Am J Hosp Palliat Care

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Context: Palliative sedation therapy (PST) can relieve suffering at end-of-life (EOL) in children with intolerable and refractory symptoms. However, updated and consistent guidance on PST practices are imperative. Objectives: We investigate current variations in clinical practice and PST implementation among pediatric palliative care (PPC) and pain management (PM) specialists. Methods: We distributed an IRB-exempt electronic anonymous survey via email through the Society of Pediatric Pain Medicine, and the American Academy of Hospice and Palliative Medicine. Survey responses were collated and descriptively reported. Results: Of 83 survey responses, the majority (75%) represented large academic children’s hospitals. The distribution between PPC and pediatric pain management specialists’ responses was 60% and 40%, respectively. Most respondents reported having designated pain management and/or palliative care teams (70% and 90%, respectively). Approximately half (48%) reported following an institutional PST protocol, most not requiring formal ethics consult (69%). Only 54% of respondents noted that the Do Not Resuscitate (DNR) order was required prior to PST initiation. PST was primarily utilized for children with oncologic diagnoses (76%). The primary and secondary medications of choice for PST implementation were reported to be opioids (39%) and benzodiazepines (36%) by pain management specialists, and benzodiazepines (52%) and barbiturates (28%) by palliative care specialists. Conclusions: Our study highlights the variability in the practice and implementation of PST. Further educational efforts are key for establishing PST practices and efficient protocol development.

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“…neste sentido, a sedação paliativa foi elencada como estratégia passível de utilização pela equipe médica para fornecer conforto podendo inclusive adotar-se tecnologias de apoio a esta prática como o uso de um mapa de sedação. Igualmente recomendável foi a inclusão do consentimento da criança e família para o uso deste recurso terapêutico, buscando assim a preservação da autonomia e a participação na tomada de decisão sobre os cuidados prestados e recebidos (HEREDIA, 2019;PULEIO et al, 2018;GÓMEZ et al, 2022;FILHO et al, 2019;NORIEGA et al, 2022).…”

Section: Resultsunclassified

Estudos Multidisciplinares Sobre Saúde Da Criança E Do Adolescente

SOUSA¹,

BARBOSA²,

MACÊDO³

et al. 2023

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A primeira edição do Congresso Brasileiro de Saúde da Criança e do Adolescente foi realizado de forma remota, nos dias 16, 17 e 18 de dezembro de 2022, sendo promovido pelo Instituto Academic (CNPJ: 42.698.982/0001-87). O evento contou com a participação de vários palestrantes renomados que discutiram temáticas relevantes sobre o cuidado à saúde da criança e adolescente. O objetivo do evento foi de promover a educação, capacitação, treinamento e atualização multidisciplinar na área da saúde da criança e do adolescente, sendo destinado a discentes, docentes, profissionais de saúde e demais interessados pela discussão da temática. O e-book é composto por 50 capítulos que servem de base para a construção do conhecimento baseado em evidências, servindo de base para reflexão, discussão e embasamento teórico para a construção de outros estudos sobre a área.

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Descriptive analysis of palliative sedation in a pediatric palliative care unit

Cited by 5 publications

References 21 publications

How do hospitalised children die? The context of death and end‐of‐life decision‐making

How do hospitalised children die? The context of death and end‐of‐life decision‐making

Palliative Sedation Therapy Practice Comparison – A Survey of Pediatric Palliative Care and Pain Management Specialists

Estudos Multidisciplinares Sobre Saúde Da Criança E Do Adolescente

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