Palliative Sedation in COVID-19 End-of-Life Care. Retrospective Cohort Study

Medicina

卷:57

Oscar Moreno-Perez¹  Nazaret Gomez-Martinez²  Joaquin Portilla-Sogorb³  Rosario Sanchez-Martinez³  Jose-Manuel Ramos-Rincon³  Ana Marti-Pastor³  Manuel Priego-Valladares⁴  Eduardo Climent-Grana⁵  Esperanza Merino⁶ 

[1] Clinical Medicine Department, Miguel Hernández University, 03550 Elche, Spain;

[2] Endocrinology and Nutrition Department, Alicante General University Hospital—Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain;

[3] Internal Medicine Department, Alicante General University Hospital—Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain;

[4] Palliative Care Unit and Internal Medicine Department, Alicante General University Hospital—Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain;

[5] Pharmacy Department, Alicante General University Hospital—Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain;

[6] Unit of Infectious Diseases, Alicante General University Hospital—Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain;

关键词: COVID-19;    palliative care;    palliative medicine;    death;    symptom assessment;   

DOI  :  10.3390/medicina57090873

来源: DOAJ

【 摘 要 】

Background and Objectives: Descriptions of end-of-life in COVID-19 are limited to small cross-sectional studies. We aimed to assess end-of-life care in inpatients with COVID-19 at Alicante General University Hospital (ALC) and compare differences according to palliative and non-palliative sedation. Material and Methods: This was a retrospective cohort study in inpatients included in the ALC COVID-19 Registry (PCR-RT or antigen-confirmed cases) who died during conventional admission from 1 March to 15 December 2020. We evaluated differences among deceased cases according to administration of palliative sedation. Results: Of 747 patients evaluated, 101 died (13.5%). Sixty-eight (67.3%) died in acute medical wards, and 30 (44.1%) received palliative sedation. The median age of patients with palliative sedation was 85 years; 44% were women, and 30% of cases were nosocomial. Patients with nosocomial acquisition received more palliative sedation than those infected in the community (81.8% [9/11] vs 36.8% [21/57], p = 0.006), and patients admitted with an altered mental state received it less (20% [6/23] vs. 53.3% [24/45], p = 0.032). The median time from admission to starting palliative sedation was 8.5 days (interquartile range [IQR] 3.0–14.5). The main symptoms leading to palliative sedation were dyspnea at rest (90%), pain (60%), and delirium/agitation (36.7%). The median time from palliative sedation to death was 21.8 h (IQR 10.4–41.1). Morphine was used in all palliative sedation perfusions: the main regimen was morphine + hyoscine butyl bromide + midazolam (43.3%). Conclusions: End-of-life palliative sedation in patients with COVID-19 was initiated quite late. Clinicians should anticipate the need for palliative sedation in these patients and recognize the breathlessness, pain, and agitation/delirium that foreshadow death.

【 授权许可】

Unknown