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Abstract(s)
Introdução: Em Cuidados Paliativos (CP) existe uma minoria de doentes terminais que apresentam sintomas refratários, levando ao uso de sedação paliativa (SP). SP consiste na redução do estado de consciência para aliviar o sofrimento nos últimos dias de vida. Existe, contudo, pouca evidência sobre características dos doentes que permitam avaliar o risco de futura SP. Este estudo pretende identificar que variáveis na admissão numa unidade de internamento de CP estão associadas à necessidade futura de SP. Material e métodos: Trata-se de um estudo observacional longitudinal retrospetivo e analítico realizado numa amostra de doentes que faleceram numa unidade de internamento de CP entre 1 de janeiro de 2020 e 31 de dezembro de 2021. A SP foi definida como a utilização de midazolam e/ou neurolépticos para tratamento de sintomas refratários nos últimos dias de vida. A associação entre as variáveis dos doentes na admissão e uso futuro de SP foi analisada. Resultados: Incluíram-se 243 pacientes, dos quais 30 receberam SP (12,3%). Na análise bivariada, foram observadas diferenças estatisticamente significativas entre os doentes sedados e não sedados em relação à idade mais jovem, estado civil, doença oncológica como diagnóstico principal, diagnóstico principal, ter antecedentes psiquiátricos, escala de Barthel elevada, ter ESAS, necessidade de acompanhamento psicológico, ter expressão de desejos, e envolvimento do doente no processo de decisões. A análise de regressão logística mostrou que apenas a idade mais jovem e ter ESAS foram preditores de SP futura. Discussão e Conclusão: Este estudo mostrou que idade mais jovem e ter ESAS (que indiretamente significa estar consciente) na admissão foram preditores de SP futura. Também se encontrou associação entre 10 variáveis e utilização de SP. Mais investigação é necessária, com desenhos de estudo mais robustos, para identificar outras determinantes de administração de SP, e investigar se intervenções precoces nessas determinantes serão eficazes para evitar a necessidade de PS.
Introduction: In Palliative Care (PC) there is a minority of terminal patients who experience refractory symptoms, leading to the use of palliative sedation (PS). PS is the reduction of consciousness to alleviate suffering in the last days of life. There is, though, little evidence on patient characteristics that allow assessing the risk of future PS. This study aims to identify which variables at the admission to an inpatient PC unit are associated with future need for PS. Material and methods: This is a retrospective and analytical longitudinal observational study performed on a sample of patients who died in a PC inpatient unit between January 1, 2020 and December 31, 2021. PS was defined as use of midazolam and/or neuroleptics for the treatment of refractory symptoms in the last days of life. The association between patient-related variables at admission and the future PS was analysed. Results: A total of 243 patients were included, of whom 30 received PS (12,3%). In univariate analysis, statistically significant differences were noted between the sedated and nonsedated patients with respect to younger age, marital status, malignancy as main diagnosis, main diagnosis, psychiatric history, higher Barthel score, have ESAS, need for psychologist follow-up, expression of wishes, and patient involvement in the decision-making process. Multivariate logistic regression analysis showed that only the younger age and have ESAS were significantly associated with PS. Discussion and Conclusion: this study showed that younger age and have ESAS at admission in a PC inpatient unit were independently positively associated with the chance of the administration of PS. It also showed association between 10 variables. Further research in this field is recommended, with more robust study designs, to identify other determinants of the administration of PS, and to investigate if early interventions on those determinants will be effective to prevent the need for future PS.
Introduction: In Palliative Care (PC) there is a minority of terminal patients who experience refractory symptoms, leading to the use of palliative sedation (PS). PS is the reduction of consciousness to alleviate suffering in the last days of life. There is, though, little evidence on patient characteristics that allow assessing the risk of future PS. This study aims to identify which variables at the admission to an inpatient PC unit are associated with future need for PS. Material and methods: This is a retrospective and analytical longitudinal observational study performed on a sample of patients who died in a PC inpatient unit between January 1, 2020 and December 31, 2021. PS was defined as use of midazolam and/or neuroleptics for the treatment of refractory symptoms in the last days of life. The association between patient-related variables at admission and the future PS was analysed. Results: A total of 243 patients were included, of whom 30 received PS (12,3%). In univariate analysis, statistically significant differences were noted between the sedated and nonsedated patients with respect to younger age, marital status, malignancy as main diagnosis, main diagnosis, psychiatric history, higher Barthel score, have ESAS, need for psychologist follow-up, expression of wishes, and patient involvement in the decision-making process. Multivariate logistic regression analysis showed that only the younger age and have ESAS were significantly associated with PS. Discussion and Conclusion: this study showed that younger age and have ESAS at admission in a PC inpatient unit were independently positively associated with the chance of the administration of PS. It also showed association between 10 variables. Further research in this field is recommended, with more robust study designs, to identify other determinants of the administration of PS, and to investigate if early interventions on those determinants will be effective to prevent the need for future PS.
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Keywords
Medicina paliativa Cuidados paliativos Sedação paliativa Sedação profunda Sintomas refratários Palliative medicine Palliative care Palliative sedation Deep sedation Refractory symptoms