• Eva Schildmann, Sebastian Pörnbacher, Helen Kalies, and Claudia Bausewein.
• Department of Palliative Medicine, University Hospital Munich, LMU Munich, Munich, Germany.
• Palliat Med. 2018 Jul 1; 32 (7): 1189-1197.

BackgroundSedatives are frequently used towards the end of life. However, there is scarce information when their use is labelled as 'palliative sedation'.AimTo assess the use and labelling of 'continuous administration of sedatives within the last 7 days of life', based on objective operational criteria, on a palliative care unit.DesignRetrospective cohort study, using medical records. Explorative statistical analysis (SPSS 23).Setting/ParticipantsPatients who died on a palliative care unit from August 2014 to July 2015. Sedatives recorded were benzodiazepines, levomepromazine, haloperidol ⩾5 mg/day and propofol.ResultsOf the 192 patients, 149 (78%) patients received continuous sedatives within the last week of life. The prevalence of delirium/agitation was significantly higher in patients with continuous sedatives compared to those without continuous sedatives at admission to the unit (35% vs 16%, p = 0.02) and on the day before death (58% vs 40%, p = 0.04). The term '(palliative) sedation' was used in the records for 22 of 149 (15%) patients with continuous sedatives. These patients had significantly higher total daily midazolam doses 2 days before death (median (range), 15.0 (6.0-185.0) mg vs 11.5 (1.0-70.0) mg, p = 0.04) and on the day of death (median (range), 19.5 (7.5-240.0) mg vs 12.5 (2.0-65.0) mg, p = 0.01). The dose range was large in both groups.ConclusionThe prevalence of delirium/agitation was associated with the administration of continuous sedatives. There was no consistent pattern regarding labelling the use of continuous sedatives as '(palliative) sedation'. Multicentre mixed-methods research is needed for a better characterization of sedation practices in palliative care.

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