Sedação paliativa

: uma revisão scoping

Abstract

Introduction: At the end of life, there are symptoms for which treatments based on scientific evidence are ineffective despite intensive efforts. Palliative sedation arises as a therapeutic option that allows relief of refractory suffering. Over the past years, protocols and recommendations have emerged, which differ in several aspects, leading to distinct palliative sedation practices. In order to standardize these practices, it is essential to understand the existing knowledge about palliative sedation. Objective: Map the preexisting knowledge on palliative sedation, namely: the definition of palliative sedation, refractory symptoms, indications for palliative sedation, palliative sedation methods, drugs and dosage used, patient care and monitoring. Methodology: A scoping review was developed, and a literature search was performed in PubMed, CINHAL, Scopus, Web of Science, Cochrane Library and Medic Latina databases. Two independent researchers performed the selection process by title, abstract, and full text. The methodological quality of the articles was assessed. Results: From a total of 4359 articles, 58 were included in this review, the majority being cross-sectional studies (37.9%) and systematic reviews (22.4%). The definition of palliative sedation should mention the reduction of the state of consciousness, the use of sedative drugs and the presence of refractory symptoms. In order to define refractory symptoms, the treatments available are defined as incapable of delivering adequate relief, having no acceptable risk-benefit, or unlikely to provide relief within a tolerable time frame. The most frequently reported refractory symptoms are delirium, dyspnea, pain and existential suffering. Palliative sedation can be classified mainly as superficial or deep and intermittent or continuous. Midazolam is the most commonly used drug for palliative sedation. Levomepromazine, chlorpromazine, propofol and phenobarbital are other referred drugs. Palliative sedation implies frequent monitoring of symptom severity and sedation levels. There should always be clinical documentation on palliative sedation purpose, its depth and level, and the drugs and dosages used. Depending on the prognosis, some authors consider evaluating vital signs pertinent. Conclusion: There are some divergences in the concepts and practices of palliative sedation. Developing new research and standard guidelines by various institutions and experts is necessary to establish consensual standards and improve palliative sedation practices.

Date of Award	26 Jul 2023
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Manuel Luís Capelas (Supervisor)