Effect of continuous deep sedation on survival in the last days of life of cancer patients: A multicenter prospective cohort study
Effect of continuous deep sedation on survival in the last days of life of cancer patients: A multicenter prospective cohort study
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DOI：
10.1177/02692163211057754
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发表时间：
2022-01-23
影响因子：
4.4
通讯作者：
Morita, Tatsuya
中科院分区：
文献类型：
--
作者：
Yokomichi, Naosuke;Yamaguchi, Takuhiro;Morita, Tatsuya
背景：持续深度镇静是否会缩短患者的生命在伦理上是有争议的。目的：观察持续深度镇静是否能缩短患者从姑息状态评分下降到20分(PPS20)的生存期。设计：多中心前瞻性队列研究(EASID研究)的一部分。地点/对象：2017年，我们在日本招募了23个参与姑息治疗的成年晚期癌症患者。我们比较了接受和没有接受持续深度镇静的患者接受PPS20治疗后的存活率。持续深度镇静被定义为持续给予镇静药物，目的是使患者持续昏迷，以缓解原本无法控制的症状，但镇静剂的剂量被调整，以实现对每个患者的充分症状缓解。采用倾向计分加权法对潜在混杂因素进行控制，并进行了5项敏感性分析。结果：共纳入1926例患者。排除活着出院的患者，我们分析了1625例患者，其中156例(9.6%)接受了持续深度镇静。1625例患者PPS20的中位生存期为81小时(95%可信区间：77-88)。RASS评分降至
Background: Continuous deep sedation is ethically controversial with respect to whether it shortens a patient's life. Aim: To examine whether continuous deep sedation shortens patient survival from the day of Palliative Performance Scale decline to 20 (PPS20). Design: A part of a multicenter prospective cohort study (EASED study). Setting/participants: We recruited consecutive adult patients with advanced cancer admitted to 23 participating palliative care units in 2017 in Japan. We compared survival from PPS20 between those who did and did not receive continuous deep sedation. Continuous deep sedation was defined as the continuous administration of sedative medication with the intention to keep a patient continuously unconscious to alleviate otherwise uncontrollable symptoms, but the dose of sedatives was adjusted to achieve adequate symptom relief for each patient. The propensity score-weighting method was used to control for potential confounders, and five sensitivity analyses were performed. Results: A total of 1926 patients were enrolled. Patients discharged alive were excluded, and we analyzed 1625 patients of whom 156 (9.6%) received continuous deep sedation. Median survival from PPS20 of 1625 patients was 81 h (95% CI: 77-88). The RASS scores decreased to