title: [Palliative sedation at a university palliative care unit--a descriptive analysis].
abstract: BACKGROUND
  Palliative sedation (pS) is indicated in the presence of end-stage disease with treatment-refractory symptoms not tolerable for the patient. We investigated the practice of pS at a university palliative care unit.
  
  
  METHODS
  Before starting pS the following data were documented: indication and decision making, type of sedation, life expectancy evaluated by the physician using the palliative prognostic index. Over the time of pS communication skills, depth of sedation, relief in symptoms, substitution of fluid and nutrition and used medications were collected.
  
  
  RESULTS
  During evaluation time 99 patients died. 34 patients received pS (34 %). All patients suffered from cancer. Indications for palliative sedation were: terminal restlessness (56 %), dyspnea (39 %), pain (32 %), psychological distress (15 %), agitated delir (9 %), vomiting (3 %) and bleeding (3 %) (multiple nominations possible). In 31 cases (91 %) nurses were included for decision making. In 33 cases continuous sedation were initiated immediately (median duration 27.5 hours). The most applied medication was midazolam (94 %), sometimes combined with neuroleptics (44 %) and propofol (15 %). 91 % of the patients additionally received opioids. Artificial fluid was substituted in two cases. Palliative sedation started in the median 27.5 hours before death. The final physician assessment revealed complete symptom relief in 12 patients (35 %), very strong symptom relief in 20 patients (59 %) and moderate symptom relief in 2 patients (6 %).
  
  
  CONCLUSIONS
  pS was successfully used as last resort for relief of treatment-refractory symptoms in one third of decedents at the investigated palliative care unit.
authors.forename: A
authors.initials: A
authors.lastname: Hopprich
authors.forename: L D
authors.initials: LD
authors.lastname: Günther
authors.forename: R
authors.initials: R
authors.lastname: Laufenberg-Feldmann
authors.forename: U
authors.initials: U
authors.lastname: Reinholz
authors.forename: M
authors.initials: M
authors.lastname: Weber
mesh_terms: D000046:Academic Medical Centers; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D016292:Procedural Sedation / Q000379:methods*; D054810:Deep Sedation / Q000379:methods*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000627:therapeutic use*; D008874:Midazolam / Q000008:administration & dosage / Q000627:therapeutic use; D009369:Neoplasms; D010166:Palliative Care / Q000379:methods*; D013727:Terminal Care / Q000379:methods*
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D008874:Midazolam