Palliative Sedation in COVID-19 End-of-Life Care. Retrospective Cohort Study
<i>Background and Objectives:</i> 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-pa...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-08-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/57/9/873 |
| _version_ | 1797518295355621376 |
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| author | Jose-Manuel Ramos-Rincon Oscar Moreno-Perez Nazaret Gomez-Martinez Manuel Priego-Valladares Eduardo Climent-Grana Ana Marti-Pastor Joaquin Portilla-Sogorb Rosario Sanchez-Martinez Esperanza Merino |
| author_facet | Jose-Manuel Ramos-Rincon Oscar Moreno-Perez Nazaret Gomez-Martinez Manuel Priego-Valladares Eduardo Climent-Grana Ana Marti-Pastor Joaquin Portilla-Sogorb Rosario Sanchez-Martinez Esperanza Merino |
| author_sort | Jose-Manuel Ramos-Rincon |
| collection | DOAJ |
| description | <i>Background and Objectives:</i> 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. <i>Material and Methods</i>: 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. <i>Results:</i> 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], <i>p</i> = 0.006), and patients admitted with an altered mental state received it less (20% [6/23] vs. 53.3% [24/45], <i>p</i> = 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%). <i>Conclusions</i>: 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. |
| first_indexed | 2024-03-10T07:27:52Z |
| format | Article |
| id | doaj.art-3ecb44d17d55440dbfb1c9984cd23fe6 |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-10T07:27:52Z |
| publishDate | 2021-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-3ecb44d17d55440dbfb1c9984cd23fe62023-11-22T14:07:33ZengMDPI AGMedicina1010-660X1648-91442021-08-0157987310.3390/medicina57090873Palliative Sedation in COVID-19 End-of-Life Care. Retrospective Cohort StudyJose-Manuel Ramos-Rincon0Oscar Moreno-Perez1Nazaret Gomez-Martinez2Manuel Priego-Valladares3Eduardo Climent-Grana4Ana Marti-Pastor5Joaquin Portilla-Sogorb6Rosario Sanchez-Martinez7Esperanza Merino8Internal Medicine Department, Alicante General University Hospital—Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, SpainClinical Medicine Department, Miguel Hernández University, 03550 Elche, SpainEndocrinology and Nutrition Department, Alicante General University Hospital—Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, SpainPalliative Care Unit and Internal Medicine Department, Alicante General University Hospital—Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, SpainPharmacy Department, Alicante General University Hospital—Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, SpainInternal Medicine Department, Alicante General University Hospital—Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, SpainInternal Medicine Department, Alicante General University Hospital—Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, SpainInternal Medicine Department, Alicante General University Hospital—Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, SpainUnit of Infectious Diseases, Alicante General University Hospital—Alicante Institute of Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain<i>Background and Objectives:</i> 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. <i>Material and Methods</i>: 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. <i>Results:</i> 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], <i>p</i> = 0.006), and patients admitted with an altered mental state received it less (20% [6/23] vs. 53.3% [24/45], <i>p</i> = 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%). <i>Conclusions</i>: 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.https://www.mdpi.com/1648-9144/57/9/873COVID-19palliative carepalliative medicinedeathsymptom assessment |
| spellingShingle | Jose-Manuel Ramos-Rincon Oscar Moreno-Perez Nazaret Gomez-Martinez Manuel Priego-Valladares Eduardo Climent-Grana Ana Marti-Pastor Joaquin Portilla-Sogorb Rosario Sanchez-Martinez Esperanza Merino Palliative Sedation in COVID-19 End-of-Life Care. Retrospective Cohort Study Medicina COVID-19 palliative care palliative medicine death symptom assessment |
| title | Palliative Sedation in COVID-19 End-of-Life Care. Retrospective Cohort Study |
| title_full | Palliative Sedation in COVID-19 End-of-Life Care. Retrospective Cohort Study |
| title_fullStr | Palliative Sedation in COVID-19 End-of-Life Care. Retrospective Cohort Study |
| title_full_unstemmed | Palliative Sedation in COVID-19 End-of-Life Care. Retrospective Cohort Study |
| title_short | Palliative Sedation in COVID-19 End-of-Life Care. Retrospective Cohort Study |
| title_sort | palliative sedation in covid 19 end of life care retrospective cohort study |
| topic | COVID-19 palliative care palliative medicine death symptom assessment |
| url | https://www.mdpi.com/1648-9144/57/9/873 |
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