Sedación paliativa en enfermedad terminal

  • Valeria Quintero Carreño Fellow Dolor y Cuidados Paliativos
  • Catalina Martínez Vásquez Residente Medicina del Dolor y Cuidados Paliativos. Universidad de la Sabana. Instituto Nacional de Cancerología. Bogotá, Colombia.
  • Claudia Agámez Insignares Grupo Dolor y cuidados paliativos, Instituto Nacional de Cancerología. Bogotá, Colombia
Palabras clave: sedación, final de la vida, cuidados paliativos, síntomas refractarios, enfermedad terminal, sufrimiento

Resumen

Algunos pacientes con enfermedad terminal que están cerca del final de la vida pueden experimentar un sufrimiento intolerable dado por síntomas refractarios a las terapias paliativas específicas. La Sedación Paliativa (SP) se considera una modalidad de tratamiento eficaz para el manejo de estos síntomas refractarios cuando los esfuerzos agresivos no proporcionan alivio. La SP consiste en el uso de medicamentos que inducen sedación y disminución del nivel de conciencia con el objetivo de aliviar el sufrimiento intolerable en los últimos días de la vida. Los síntomas físicos refractarios más frecuentes son el dolor, delirium y disnea, sin embargo, la SP también se indica para tratar el sufrimiento existencial o la angustia psicológica, que es un problema extremadamente difícil y delicado. La SP ha sido ampliamente debatida por las obvias implicaciones éticas, socioculturales y de toma de decisiones.  Se ha reportado que la SP se proporciona entre el 2% y el 52% de los pacientes con enfermedades terminales. Los estudios han sugerido que la SP es exitosa en el manejo de los síntomas intratables al final de la vida, no genera efectos perjudiciales sobre la supervivencia y es satisfactoria para los familiares.

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Referencias

Claessens P, Menten J, Schotsmans P, Broeckaert B. Palliative Sedation: A Review of the Research Literature. J Pain Symptom Manage. 2008;36(3):310–33. https://doi.org/10.1016/j.jpainsymman.2007.10.004

Bodnar J, Bodnar J. A Review of Agents for Palliative Sedation / Continuous Deep Sedation : Pharmacology and Practical Applications. J Pain Palliat Care Pharmacother [Internet]. 2017;31(1):16–37. Available from: http://dx.doi.org/10.1080/15360288.2017.1279502.

Enck RE. Drug-induced terminal sedation for symptom control. Am J Hosp Palliat Med. 1991;8(5):3–5. https://doi.org/10.1177/104990919100800501

Have H, Welie JVM. Palliative Sedation Versus Euthanasia : An Ethical Assessment. J Pain Symptom Manage [Internet]. 2019;47(1):123–36. Available from: http://dx.doi.org/10.1016/j.jpainsymman.2013.03.008.

Trota RA, Aguilar AG, Vidal PL, Flores JR, Pozo RRDEL, Aguirre YV, et al. Aspectos éticos de la sedación en Cuidados Paliativos*. 2002;9:41–6.

Pastrana T, De Lima L, Pons JJ, Centeno C. Atlas de Cuidados Paliativos en Latinoamérica- Edición Cartográfica 2013 [Internet]. 2013. 1–72 p. Available from: www.cuidadospaliativos.org

Santos D, Della Valle A, Barlocco B, Pereyra J, Bonilla D. Sedación paliativa: experiencia en una unidad de cuidados paliativos de Montevideo. Rev Médica del Uruguay. 2009;25(2):78–83.

Parra Palacio S, Giraldo Hoyos CE, Arias Rodríguez C, Mejía Arrieta D, Vargas Gómez JJ, Krikorian A. Palliative sedation in advanced cancer patients hospitalized in a specialized palliative care unit. Support Care Cancer. 2018;26(9):3173–80. https://doi.org/10.1007/s00520-018-4164-7

Cherny NI, Radbruch L, Chasen M, Coyle N, Charles D, Dean M, et al. European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliat Med. 2009;23(7):581–93. https://doi.org/10.1177/0269216309107024

Sanchez M, Cuervo M. Guia Clinica. Sedacion del prcpex, uso y recomendaciones. Programa Reg Cuid Paliativos Extrem [Internet]. 2014;91. Available from: http://www.secpal. com/%5CDocumentos%5CBlog%5Cguia-de-sedacion.pdf

Palliative D, Shorten S, Lives THE, Patients OF. ¿La sedación paliativa acorta la vida de los pacientes? 2017;204–18.

Nogueira FL, Sakata RK. Sedación Paliativa del Paciente Terminal. 2012;62:1–7.

Henry B. A systematic literature review on the ethics of palliative sedation : an update ( 2016 ). 2016;6100:201–7. https://doi.org/10.1097/SPC.0000000000000224

Maltoni M, Setola E. Palliative Sedation in Patients With Cancer. 2015;433–41. https://doi.org/10.1177/107327481502200409

Cherny NI, Guidelines E, Group W. ESMO Clinical Practice Guidelines for the management of refractory symptoms at the end of life and the use of palliative sedation. ESMO Updat Clin Pract Guidel [Internet]. 2014;25(July):iii143–52. Available from: http://dx.doi.org/10.1093/annonc/mdu238

Morrison K, Youngwerth J. Palliative Sedation Therapy. Hosp Med Clin [Internet]. 2016;5(1):101–13. Available from: http://dx.doi.org/10.1016/j.ehmc.2015.08.010

Bobb B. A Review of Palliative Sedation. Nurs Clin NA [Internet]. 2016;51(3):449–57. Available from: http://dx.doi.org/10.1016/j.cnur.2016.05.008

Muller-Busch HC, Andres I, Jehser T. Sedation in palliative care - A critical analysis of 7 years experience. BMC Palliat Care. 2003;2:1–9. https://doi.org/10.1186/1472-684X-2-2

Teunissen SCCM, Wesker W, Kruitwagen C, de Haes HCJM, Voest EE, de Graeff A. Symptom Prevalence in Patients with Incurable Cancer: A Systematic Review. J Pain Symptom Manage. 2007;34(1):94–104. https://doi.org/ 10.1016/j.jpainsymman.2006.10.015

Maltoni M, Scarpi E, Nanni O. Palliative sedation for intolerable suffering. 2014;389–94. https://doi.org/10.1097/CCO.0000000000000097

Mercadante S, Porzio G, Valle A, Fusco F, Aielli F, Costanzo V. Palliative sedation in patients with advanced cancer followed at home: A systematic review. J Pain Symptom Manage [Internet]. 2011;41(4):754–60. Available from: http://dx.doi.org/10.1016/j.jpainsymman.2010.07.013

Song HN, Lee US, Lee GW, Hwang IG, Kang JH, Eduardo B. Long-Term Intermittent Palliative Sedation for Refractory Symptoms at the End of Life in Two Cancer Patients. J Palliat Med. 2015;18(9):807–10. https://doi.org/10.1089/jpm.2014.0357

Garetto F, Cancelli F, Rossi R, Maltoni M. Palliative Sedation for the Terminally Ill Patient. CNS Drugs [Internet]. 2018;(0123456789). Available from: https://doi.org/10.1007/s40263-018-0576-7

Bruera E, Hui D, Dalal S, Torres-Vigil I, Trumble J, Roosth J, et al. Parenteral hydration in patients with advanced cancer: A multicenter, double-blind, placebo-controlled randomized trial. J Clin Oncol. 2013;31(1):111–8. https://doi.org/ 10.1200/JCO.2012.44.6518

Textbook O. Palliative Nursing. Palliat Nurs. 2009;440–8.

Bruce A, Boston P. Relieving existential suffering through palliative sedation: Discussion of an uneasy practice. J Adv Nurs. 2011;67(12):2732–40. https://doi.org/ 10.1111/j.1365-2648.2011.05711.x

De Graeff A, Dean M. Palliative sedation therapy in the last weeks of life: A literature review and recommendations for standards. J Palliat Med. 2007;10(1):67–85. https://doi.org/10.1089/jpm.2006.0139

Kirk TW, Mahon MM. National Hospice and Palliative Care Organization (NHPCO) Position Statement and Commentary on the Use of Palliative Sedation in Imminently Dying Terminally Ill Patients. J Pain Symptom Manage [Internet]. 2010;39(5):914–23. Available from: http://dx.doi.org/10.1016/j.jpainsymman.2010.01.009

Booker R, Bruce A. Palliative sedation and medical assistance in dying: Distinctly different or simply semantics? Nurs Inq. 2020;27(1):1–9. https://doi.org/ 10.1111/nin.12321

Statement on Palliative Sedation. Am Acad Hosp Palliat Med [Internet]. 2014; Available from: http://aahpm.org/positions/palliative-sedation

Back AL, Anderson WG, Bunch L, Marr LA, Wallace JA, Yang HB, et al. Communication about cancer near the end of life. Cancer. 2008;113(7):1897–910. https://doi.org/10.1002/cncr.23653

Carmona-espinazo F, Sánchez-prieto F. REVISTA ESPAÑOLA DE Nuestra experiencia en sedación paliativa como opción terapéutica en pacientes en situación clínica de últimos días. Rev Española Med Leg [Internet]. 2016;(xx):1–5. Available from: http://dx.doi.org/10.1016/j.reml.2015.12.001

Tapiero AA. La sedación terminal . Aspectos éticos. 2003;20:645–9.

Sulistio M, Wojnar R, Michael NG. Propofol for palliative sedation. 2019;1–3. https://doi.org/10.1136/bmjspcare-2019-001899

Deol H, Dimtri F, Minaie A, Surani S, Udeani G. Role of Ramsay Sedation Scale in Sedative Dosage Modulation for Critically-Ill Intubated Patients. Chest [Internet]. 2017;152(4):A330. Available from: https://doi.org/10.1016/j.chest.2017.08.356

Deol HS, Surani SR, Udeani G. Inter-rater Reliability of the Ramsay Sedation Scale for Critically-ill Intubated Patients. Cureus. 2019;11(10). https://doi.org/ 10.7759/cureus.6021

Ely EW, Truman B, Thomason JWW, Wheeler AP, Gordon S, Francis J, et al. Monitoring Sedation Status Over Time in ICU Patients. 2014;289(22):2983–91. https://doi.org/10.1001/jama.289.22.2983

Maltoni M, Scarpi E, Rosati M, Derni S, Fabbri L, Martini F, et al. Palliative sedation in end-of-life care and survival: A systematic review. J Clin Oncol. 2012;30(12):1378–83. https://doi.org/10.1200/JCO.2011.37.3795

Prado BL, Bugano D, Gomes D, Luiz P, Usón S, Taranto P, et al. Continuous palliative sedation for patients with advanced cancer at a tertiary care cancer center. 2018;1–7. https://doi.org/10.1186/s12904-017-0264-2

Jansen LA. Disambiguating clinical intentions: The ethics of palliative sedation. J Med Philos. 2010;35(1):19–31. https://doi.org/10.1093/jmp/jhp056

Mercadante S, Intravaia G, Villari P, Ferrera P, David F, Casuccio A. Controlled Sedation for Refractory Symptoms in Dying Patients. J Pain Symptom Manage [Internet]. 2009;37(5):771–9. Available from: http://dx.doi.org/10.1016/j.jpainsymman.2008.04.020

Chessa F. Ethical and Legal Considerations in End-of- Life Care. 2019;46:387–98. https://doi.org/10.1016/j.pop.2019.05.005

Berger JT. The proportionate value of proportionality in palliative sedation. J Clin ethics, 25(3), 219–221. 2014

Beller EM, van Driel ML, Mcgregor L, Truong S, Mitchell G. Palliative pharmacological sedation for terminally ill adults. Cochrane Database Syst Rev. 2015;2017(6). https://doi.org/10.1002/14651858.CD010206.pub2

Taboada P. Sedación paliativa (parte ii). cuestiones éticas y principios morales 1. Acta Bioeth. 2014;20(2):225–35.

Raijmakers NJH, van Zuylen L, Costantini M, Caraceni A, Clark J, Lundquist G, et al. Artificial nutrition and hydration in the last week of life in cancer patients. A systematic literature review of practices and effects. Ann Oncol. 2011;22(7):1478–86. https://doi.org/10.1093/annonc/mdq620.

Gurschick L, Mayer DK, Hanson LC. Palliative Sedation : An Analysis of International Guidelines and Position Statements. 2015;32(6):660–71. https://doi.org/10.1177/1049909114533002

Dev R, Dalal S, Bruera E. Is there a role for parenteral nutrition or hydration at the end of life? Curr Opin Support Palliat Care. 2012;6(3):365–70. https://doi.org/10.1097/SPC.0b013e328356ab4a.

HPNA Position Paper: Palliative Sedation at the End of Life. J Hosp Palliat Nurs. 2003;5(4):235–7.

One W. Artificial Nutrition and Hydration in End-of-Life Care HPNA Position Paper Approved. Hosp Today. 2004;22(5):341–5. h.ttps://doi.org/10.1097/00004045-200405000-00016

Quill TE. Responding to Intractable Terminal Suffering. Ann Intern Med. 2000;133(7):561. https://doi.org/10.7326/0003-4819-133-7-200010030-00022

Publicado
2021-09-23
Cómo citar
[1]
Quintero Carreño, V., Martínez Vásquez, C. y Agámez Insignares, C. 2021. Sedación paliativa en enfermedad terminal. Revista Colombiana de Cancerología. 26, 1 (sep. 2021), 3-13. DOI:https://doi.org/10.35509/01239015.702.
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