title: To explore the relationship between the use of midazolam and cessation of oral intake in the terminal phase of hospice inpatients: A retrospective case note review: Does midazolam affect oral intake in the dying?
abstract: Sedative drugs are used to improve comfort in dying patients but have been accused of shortening survival by reducing patients' ability to maintain nutrition and hydration. However, as part of the dying process, patients in the last days of life often have impaired conscious levels and an inability to maintain oral intake.
  
  
  
  To establish whether the decline in oral intake is related to the use of midazolam in the last week of life.
  
  
  
  This is a retrospective case note review.
  
  
  
  The data were obtained from nursing records and medication charts of 125 consecutive hospice inpatients who died at a hospice in South London.
  
  
  
  A total of 72 patients received midazolam on one or more days within the last 7 days of life (midazolam group) and 49 patients received no midazolam (control group).
  
  
  
  Mean oral intake was reduced 7 days prior to death and declined sequentially over subsequent days in both patient groups. More patients required midazolam as death approached and most patients received midazolam for less than 3 days. Mean doses of midazolam used were low. Patients in the midazolam group had lower oral intake than those in the control group, but this association does not indicate causation.
authors.affiliation: St Christopher's Hospice, London, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Giles
authors.affiliation: St Christopher's Hospice, London, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Sykes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D004435:Eating / Q000187:drug effects*; D005260:Female; D017051:Hospice Care / Q000379:methods; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008874:Midazolam / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods*
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam
keywords: Hospices; eating; hypnotics and sedatives; palliative care; palliative sedation; terminal care