The clinical practice of palliative sedation in terminally ill patients: a review

Authors

DOI:

https://doi.org/10.34024/rnc.2025.v33.19414

Keywords:

Palliative care, Terminally ill, Deep sedation, Conscious sedation

Abstract

Objective. To clarify the main conflicting aspects of the clinical practice of palliative sedation (PS) that make it impossible to use it satisfactorily to relieve the intolerable suffering of terminally ill patients. Method. A scoping review guided by the PRISMA-ScR script, which included 12 articles at the end of the selection based on the eligibility criteria. The databases used were PubMed, Scopus, VHL, EMBASE and Google Scholar. Results. There is no consensus on the definition of symptom refractoriness; professionals fail to distinguish temporality and intensity; the management of adverse effects and the maintenance of morphine as the opioid of choice for the control of dyspnea and respiratory distress are not defined; there are no criteria for the periodicity and application of the RASS scale; and there is a lack of agreement on the maintenance of hydration and nutritional support. Conclusion. It was possible to discuss the conflicting aspects of PS clinical practice, clarifying medical professionals their role within palliative care.

Metrics

Metrics Loading ...

References

Cherny NI, Radbruch L. European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliat Med 2009;23:581-93. https://doi.org/10.1177/0269216309107024

Messias AA, Maiello APMV, Coelho FP, D’Alessandro MPS, Castro ACP, Borges APS, et al. Manual de Cuidados Paliativos. São Paulo: Hospital Sírio-Libanês; Ministério da Saúde; 2020.

Hospital das Clínicas Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). Manual da residência de cuidados paliativos. Barueri: Manole; 2018.

Nogueira FL, Sakata RK. Sedação Paliativa do Paciente Terminal. Rev Bras Anestesiol 2012;62:580-92. https://doi.org/10.1590/S0034-70942012000400012

Academia Nacional de Cuidados Paliativos. Manual de Cuidados Paliativos ANCP. Rio Grande do Sul: Academia Nacional de Cuidados Paliativos; 2012.

Claessens P, Menten J, Schotsmans P, Broeckaert B. Palliative sedation: A review of the research literature. J Pain Symptom Manage 2008;36:310-33. https://doi.org/10.1016/j.jpainsymman.2007.10.004

Lux MR, Protus BM, Kimbrel J, Grauer P. A Survey of Hospice and Palliative Care Physicians Regarding Palliative Sedation Practices. Am J Hosp Palliat Care 2017;34:217-22. https://doi.org/10.1177/1049909115615128

Ferreira SP. Experiência do programa de cuidados paliativos do Hospital do Servidor Público Estadual de São Paulo. Rev Prática Hosp 2006;8:55-8. https://doi.org/10.31744/einstein_journal/2020AO5395

Piedade MAO, Cardoso Filho CA, Priolli DG. Prevalência de sedação paliativa no Estado de São Paulo: uma demanda médica emergente. Einstein 2020;18:1-9. https://doi.org/10.31744/einstein_journal/2020AO5395

Santos WM, Secoli SR, Püschel VAA. The Joanna Briggs Institute approach for systematic reviews. Rev Lat Am Enfermagem 2018;26:e3074. https://doi.org/10.1590/1518-8345.2885.3074

Tricco AC, Antony J, Soobiah C, Kastner M, Cogo E, MacDonald H, et al. Knowledge synthesis methods for generating or refining theory: a scoping review reveals that little guidance is available. J Clin Epidemiol 2016;73:36-42. https://doi.org/10.1016/j.jclinepi.2015.11.021

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71

Arantzamendi M, Belar A, Payne S, Rijpstra M, Preston N, Menten J, et al. Clinical Aspects of Palliative Sedation in Prospective Studies. A Systematic Review. J Pain Symptom Manage 2021;61:831-44. https://doi.org/10.1016/j.jpainsymman.2020.09.022

Belar A, Arantzamendi M, Payne S, Preston N, Rijpstra M, Hasselaar J, et al. How to measure the effects and potential adverse events of palliative sedation? An integrative review. Palliat Med 2021;35:295-314. https://doi.org/10.1177/0269216320974264

Garetto F, Cancelli F, Rossi R, Maltoni M. Palliative Sedation for the Terminally Ill Patient. CNS Drugs 2018;32:951-61. https://doi.org/10.1007/s40263-018-0576-7

Won YW, Chun HS, Seo M, Kim RB, KimJH, KangJH. Clinical Patterns of Continuous and Intermittent Palliative Sedation in Patients With Terminal Cancer: A Descriptive, Observational Study. J Pain Symptom Manage 2019;58:65-71. https://doi.org/10.1016/j.jpainsymman.2019.04.019

Chen Y, Jiang J, Peng W, Zhang C. Palliative sedation for children at end of life: a retrospective cohort study. BMC Palliative Care 2022;21:57. https://doi.org/10.1186/s12904-022-00947-y

Cherny NI, Radbruch L. Board of the European Association for Palliative Care. European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliat Med 2009;23:581-93. https://doi.org/10.1177/0269216309107024

Maltoni M, Pittureri C, Scarpi E, Piccinini L, Martini F, Turci P, et al. Palliative sedation therapy does not hasten death: results from a prospective multicenter study. Ann Oncol 2009;20:1163-9. https://doi.org/10.1093/annonc/mdp048

Claessens P, Menten J, Schotsmans P, Broeckaert B. Palliative sedation: a review of the research. J Pain Symptom Manage 2008;36:310-33. https://doi.org/10.1016/j.jpainsymman.2007.10.004

Santos RB, Gomes CM, Bonadio CB, Ferreira PD, Bertequini RB, Rodrigues LF. Estudo Observacional Retrospectivo sobre o Perfil de pacientes que Receberam Terapia de Sedação Paliativa em Unidade de Cuidados Paliativos do Hospital de Câncer no Brasil. Rev Bras Cancerol 2019;65:e-09324. https://doi.org/10.32635/2176-9745.RBC.2019v65n1.324

Menezes MS, Figueiredo MD. O papel da sedação paliativa no fim da vida: aspectos médicos e éticos – Revisão. Rev Bras Anestesiol 2019;69:72-7. https://doi.org/10.1016/j.bjan.2018.03.002

Abreu JPBS. Sedação paliativa contínua e intermitente: a propósito de um caso clínico (Tese). Lisboa: Faculdade de Medicina, Universidade de Lisboa; 2016. 33p. http://hdl.handle.net/10451/27528

Morita T, Chinone Y, Ikenaga M, Miyoshi M, Nakaho T, Nishitateno K, et al. Japan Pain, Palliative Medicine, Rehabilitation, and Psycho-Oncology Study Group. Ethical validity of palliative sedation therapy: a multicenter, prospective, observational study conducted on specialized palliative care units in Japan. J Pain Symptom Manage 2005;30:308-19. https://doi.org/10.1016/j.jpainsymman.2005.03.016

Matsumoto DY. Cuidados Paliativos: conceitos, fundamentos e princípios. In: Academia Nacional de Cuidados Paliativos. Manual de Cuidados Paliativos ANCP. Rio Grande do Sul: Academia Nacional de Cuidados Paliativos; 2012. p. 23-30.

Cherny NI. ESMO clinical practice guidelines for the management of refractory symptoms at the end of life and the use of palliative sedation. Ann Oncol 2014;25:143-52. https://doi.org/10.1093/annonc/mdu238

Published

2025-03-25

Issue

Section

Artigos de Revisão

How to Cite

1.
de Castro Algayer A, Cunha CROB e J da C. The clinical practice of palliative sedation in terminally ill patients: a review. Rev Neurocienc [Internet]. 2025 Mar. 25 [cited 2025 Dec. 14];33:1-19. Available from: https://periodicos.unifesp.br/index.php/neurociencias/article/view/19414
Received 2024-08-30
Accepted 2025-03-12
Published 2025-03-25