Sedación paliativa en la agonía realizada por un servicio de urgencias de atención primaria a nivel domiciliario. Estudio observacional transversal descriptivo retrospectivo

Abstract

Objectives. The objective of this study was to know the characteristics of palliative sedation in agony at the home level carried out by personnel not specialized in palliative care and to detect areas for improvement. Material and method. Retrospective descriptive cross-sectional observational study. All patients who died at home between September 2020 and February 2021, who required sedation indicated by the Primary Care Emergency Service (SUAP) Malaga, were included. Results. The percentage of palliative sedation was 16.4░% [9.8░%-23.2░%]. Only 36░% [27░%-45░%] of the patients were included in the palliative care process. In 67.2░% [59░%-76░%] of the cases, they were non-cancer chronic. Dyspnea was the most prevalent symptom (76.1░% [68░%-83░%]). Delirium was present in 21.4░% [13░%-28░%] of the patients. The most widely used drug was midazolam (94.9░% [91░%-99░%]). The mean time that passes from the start of sedation to death is 24.3h [19.3h-29.2h]. The differences in the mean survival rates between men 20.765 [13.7-27.7] and women 29.2 [22.1-33.3] were statistically significant. 72░%[64░%-80░%] of the patients did not receive any type of follow-up from the start of sedation to death. Conclusions. There is agreement between the results obtained in this study and those found in the consulted bibliography, regarding the proportion of patients with palliative sedation in agony, duration of the same and the main drugs used. The mean age of the patients was higher in this study, as well as the prevalence of nononcological chronic disease and dyspnea as the main refractory symptom. The lack of knowledge of the level of sedation in our patients, the lack of follow-up and the underuse of levomepromazine in delirium is striking.