title: Sedation at the end of life - a nation-wide study in palliative care units in Austria.
abstract: BACKGROUND
  Sedation is used to an increasing extent in end-of-life care. Definitions and indications in this field are based on expert opinions and case series. Little is known about this practice at palliative care units in Austria.
  
  
  METHODS
  Patients who died in Austrian palliative care units between June 2012 and June 2013 were identified. A predefined set of baseline characteristics and information on sedation during the last two weeks before death were obtained by reviewing the patients' charts.
  
  
  RESULTS
  The data of 2414 patients from 23 palliative care units were available for analysis. Five hundred two (21 %) patients received sedation in the last two weeks preceding their death, 356 (71 %) received continuous sedation until death, and 119 (24 %) received intermittent sedation. The median duration of sedation was 48 h (IQR 10-72 h); 168 patients (34 %) were sedated for less than 24 h. Indications for sedation were delirium (51 %), existential distress (32 %), dyspnea (30 %), and pain (20 %). Midazolam was the most frequently used drug (79 %), followed by lorazepam (13 %), and haloperidol (10 %). Sedated patients were significantly younger (median age 67 years vs. 74 years, p ≤ 0.001, r = 0.22), suffered more often from an oncological disease (92 % vs. 82 %, p ≤ 0.001, φ = 0.107), and were hospitalized more frequently (94 % vs. 76 %, p ≤ 0.001, φ = 0.175). The median number of days between admission to a palliative care ward/mobile palliative care team and death did not differ significantly in sedated versus non-sedated patients (10 vs. 9 days; p = 0.491).
  
  
  CONCLUSIONS
  This study provides insights into the practice of end-of-life sedation in Austria. Critical appraisal of these data will serve as a starting point for the development of nation-wide guidelines for palliative sedation in Austria.
authors.affiliation: Clinical Division of Palliative Care, Department for Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. sophie.schur@meduniwien.ac.at.
authors.forename: Sophie
authors.initials: S
authors.lastname: Schur
authors.affiliation: Palliative Support Team, Landesklinikum Horn, Austria.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Weixler
authors.affiliation: Mobile Hospice and Palliative Care Team, Tiroler Hospizgemeinschaft, Innsbruck, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Gabl
authors.affiliation: Department of Internal Medicine, University Hospital Krems, Krems, Austria.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Kreye
authors.affiliation: Department of Anaesthesiology and Intensive Medicine, Interdisciplinary Center of Pain Therapy and Palliative Medicine, General Hospital Klagenfurt, Klagenfurt, Austria.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Likar
authors.affiliation: Clinical Division of Palliative Care, Department for Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Eva Katharina
authors.initials: EK
authors.lastname: Masel
authors.affiliation: Clinical Division of Palliative Care, Department for Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Mayrhofer
authors.affiliation: Department for Palliative Care, Salzkammergut-Klinikum, Vöcklabruck, Austria.
authors.forename: Franz
authors.initials: F
authors.lastname: Reiner
authors.affiliation: Department of Internal Medicine, Krankenhaus der Elisabethinen, Graz, Austria.
authors.forename: Barbara
authors.initials: B
authors.lastname: Schmidmayr
authors.affiliation: Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Kirchheiner
authors.affiliation: Clinical Division of Palliative Care, Department for Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Herbert Hans
authors.initials: HH
authors.lastname: Watzke
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria; D054810:Deep Sedation / Q000379:methods / Q000706:statistics & numerical data*; D003693:Delirium / Q000188:drug therapy; D004417:Dyspnea; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy; D010166:Palliative Care / Q000379:methods*; D000070659:Patient Comfort; D012189:Retrospective Studies; D012737:Sex Factors; D013315:Stress, Psychological / Q000188:drug therapy; D013727:Terminal Care / Q000379:methods*; D013997:Time Factors
chemical_list: D006993:Hypnotics and Sedatives
keywords: Palliative care; Sedation; Symptom management