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Efficacy of two types of palliative sedation therapy defined using intervention protocols: proportional vs. deep sedation

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Abstract

Purpose

This study investigated the effect of two types of palliative sedation defined using intervention protocols: proportional and deep sedation.

Methods

We retrospectively analyzed prospectively recorded data of consecutive cancer patients who received the continuous infusion of midazolam in a palliative care unit. Attending physicians chose the sedation protocol based on each patient’s wish, symptom severity, prognosis, and refractoriness of suffering. The primary endpoint was a treatment goal achievement at 4 h: in proportional sedation, the achievement of symptom relief (Support Team Assessment Schedule (STAS) ≤ 1) and absence of agitation (modified Richmond Agitation-Sedation Scale (RASS) ≤ 0) and in deep sedation, the achievement of deep sedation (RASS ≤ − 4). Secondary endpoints included mean scores of STAS and RASS, deep sedation as a result, and adverse events.

Results

Among 398 patients who died during the period, 32 received proportional and 18 received deep sedation. The treatment goal achievement rate was 68.8% (22/32, 95% confidence interval 52.7–84.9) in the proportional sedation group vs. 83.3% (15/18, 66.1–100) in the deep sedation group. STAS decreased from 3.8 to 0.8 with proportional sedation at 4 h vs. 3.7 to 0.3 with deep sedation; RASS decreased from + 1.2 to − 1.7 vs. + 1.4 to − 3.7, respectively. Deep sedation was needed as a result in 31.3% (10/32) of the proportional sedation group. No fatal events that were considered as probably or definitely related to the intervention occurred.

Conclusion

The two types of intervention protocol well reflected the treatment intention and expected outcomes. Further, large-scale cohort studies are promising.

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Acknowledgements

This study was conducted with the cooperation of the palliative care unit of the Seirei Mikatahara General Hospital. The authors would like to thank all the participants. This study was supported by the Japanese Society for the Promotion of Science KAKENHI Grant Number JP16H05212.

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Authors and Affiliations

  1. Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan

    Kengo Imai, Naosuke Yokomichi, Akemi Shirado Naito, Hiroaki Tsukuura, Toshihiro Yamauchi & Satoshi Inoue

  2. Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan

    Tatsuya Morita

  3. Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan

    Masanori Mori

  4. Department of Practical Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan

    Takashi Kawaguchi

  5. Department of Nursing, Seirei Mikatahara General Hospital, Hamamatsu, Japan

    Kaori Fukuta

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  1. Kengo Imai
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Correspondence to Kengo Imai.

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Imai, K., Morita, T., Yokomichi, N. et al. Efficacy of two types of palliative sedation therapy defined using intervention protocols: proportional vs. deep sedation. Support Care Cancer 26, 1763–1771 (2018). https://doi.org/10.1007/s00520-017-4011-2

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