title: Palliative sedation at the end of life at a tertiary cancer center.
abstract: OBJECTIVE
  The aim of this study was to describe the use of palliative sedation (PS) its indications and outcomes in patients followed up till death by an inpatient palliative care consult team (PCCT) at a tertiary cancer center.
  
  
  METHODS
  All patients referred for 5 years to the PCCT and followed up till death were eligible for the study. Both PCCT recordings and hospital charts were reviewed and a codified assessment was performed.
  
  
  RESULTS
  Over a total of 2,033 consecutive consults, 129 patients died during admission and were eligible. Eighty-three had the indication to PS, 4% of all consults (95% confidence interval [95%CI], 3% to 5%) and 64% of eligible patients (95%CI, 56% to 73%). PS was more frequently indicated in males and in patients with recurrent dyspnea and recurrent agitation, while it was less frequently indicated in older people and in patients with cerebral metastases and recurrent drowsiness. The most frequent indications to PS were dyspnea (37%) and delirium (31%) alone or combined with other symptoms. PS was successfully achieved in 69 patients; the drugs most frequently used for PS were midazolam (46%), haloperidol (35%), and chlorpromazine (32%) and opioid dose escalation was higher in sedated patients (P < 0.01).
  
  
  CONCLUSIONS
  PS is an important intervention in the management of terminal disease by a consulting palliative care team. Improved collaboration and communication between the hospital staff and the PCCT should be offered to meet patients' needs when PS is required.
authors.affiliation: Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS-Istituto Nazionale dei Tumori-Milano, Via Venezian 1, 20133, Milan, Italy.
authors.forename: Augusto
authors.initials: A
authors.lastname: Caraceni
authors.forename: Ernesto
authors.initials: E
authors.lastname: Zecca
authors.forename: Cinzia
authors.initials: C
authors.lastname: Martini
authors.forename: Giovanna
authors.initials: G
authors.lastname: Gorni
authors.forename: Tiziana
authors.initials: T
authors.lastname: Campa
authors.forename: Cinzia
authors.initials: C
authors.lastname: Brunelli
authors.forename: Franco
authors.initials: F
authors.lastname: De Conno
mesh_terms: D000367:Age Factors; D000368:Aged; D002173:Cancer Care Facilities; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology*; D010166:Palliative Care / Q000379:methods*; D010348:Patient Care Team; D012017:Referral and Consultation; D012189:Retrospective Studies; D012737:Sex Factors
chemical_list: D006993:Hypnotics and Sedatives