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

Por: Ramos-Rincon, J, Moreno-Perez, O, Gomez-Martinez, N, Priego-Valladares, M, Climent-Grana, E, Marti-Pastor, A, Portilla-Sogorb, J, Sanchez-Martinez, R and Merino, E

Publicada: 1 sep 2021 Ahead of Print: 26 ago 2021
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.

Ramos-Rincon, Jose-Manuel: Spain
Moreno-Perez, Oscar: Spain
Gomez-Martinez, Nazaret: Spain
Priego-Valladares, Manuel: Spain
Climent-Grana, Eduardo: Spain
Marti-Pastor, Ana: Spain
Portilla-Sogorb, Joaquin: Spain
Sanchez-Martinez, Rosario: Spain
Merino, Esperanza: Spain
ISSN: 16489144

Kauno Medicinos Universitetas, ST ALBAN-ANLAGE 66, CH-4052 BASEL, SWITZERLAND, Lituania
Tipo de documento: Article
Volumen: 57 Número: 9
WOS Id: 000699868700001
ID de PubMed: 34577796
imagen Green Published, gold