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Dexmedetomidine use for patients in palliative care with intractable pain and delirium: A retrospective study
Patients seen by the palliative care team often have difficult and intractable symptoms. The current standard of practice to manage these symptoms is the deeply sedating midazolam continuous subcutaneous infusion for patients who are expected to expire within hours to days. Dexmedetomidine provides...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10530014/ https://www.ncbi.nlm.nih.gov/pubmed/37756303 http://dx.doi.org/10.1371/journal.pone.0292016 |
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author | Yu, Shi-Yuan Schellenberg, Jacqueline Alleyne, Alison |
author_facet | Yu, Shi-Yuan Schellenberg, Jacqueline Alleyne, Alison |
author_sort | Yu, Shi-Yuan |
collection | PubMed |
description | Patients seen by the palliative care team often have difficult and intractable symptoms. The current standard of practice to manage these symptoms is the deeply sedating midazolam continuous subcutaneous infusion for patients who are expected to expire within hours to days. Dexmedetomidine provides sedation but lacks evidence in palliative care use. This study describes continuous subcutaneous infusion of dexmedetomidine’s effect on refractory pain and delirium. Retrospective, observational chart review and conducted in accordance with SQUIRE (quality improvement study). Twenty adult patients (18 years of age or older) with metastatic cancer disease admitted to three palliative complex care units of Fraser Health who received continuous subcutaneous infusion of dexmedetomidine between January 2017 to August 31, 2019. Average length of dexmedetomidine use was 9 days (1/3 length of stay). Eight of the 13 patients with pain symptoms exhibited an overall decline in pain. Four of the 6 patients with delirium had an initial decrease in delirium, but it did not last beyond the first day. Despite progressive clinical deterioration, adjunctive medications decreased or remained the same for 53% of as needed medications and 65% for regularly scheduled medications. Forty-five percent of patients had ≥50% days of rousable sedation. Hypotension occurred in 85% of patients. Dexmedetomidine provided benefit in managing intractable pain while allowing patients to remain rousable, but only had a short effect on delirium symptoms. |
format | Online Article Text |
id | pubmed-10530014 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-105300142023-09-28 Dexmedetomidine use for patients in palliative care with intractable pain and delirium: A retrospective study Yu, Shi-Yuan Schellenberg, Jacqueline Alleyne, Alison PLoS One Research Article Patients seen by the palliative care team often have difficult and intractable symptoms. The current standard of practice to manage these symptoms is the deeply sedating midazolam continuous subcutaneous infusion for patients who are expected to expire within hours to days. Dexmedetomidine provides sedation but lacks evidence in palliative care use. This study describes continuous subcutaneous infusion of dexmedetomidine’s effect on refractory pain and delirium. Retrospective, observational chart review and conducted in accordance with SQUIRE (quality improvement study). Twenty adult patients (18 years of age or older) with metastatic cancer disease admitted to three palliative complex care units of Fraser Health who received continuous subcutaneous infusion of dexmedetomidine between January 2017 to August 31, 2019. Average length of dexmedetomidine use was 9 days (1/3 length of stay). Eight of the 13 patients with pain symptoms exhibited an overall decline in pain. Four of the 6 patients with delirium had an initial decrease in delirium, but it did not last beyond the first day. Despite progressive clinical deterioration, adjunctive medications decreased or remained the same for 53% of as needed medications and 65% for regularly scheduled medications. Forty-five percent of patients had ≥50% days of rousable sedation. Hypotension occurred in 85% of patients. Dexmedetomidine provided benefit in managing intractable pain while allowing patients to remain rousable, but only had a short effect on delirium symptoms. Public Library of Science 2023-09-27 /pmc/articles/PMC10530014/ /pubmed/37756303 http://dx.doi.org/10.1371/journal.pone.0292016 Text en © 2023 Yu et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Yu, Shi-Yuan Schellenberg, Jacqueline Alleyne, Alison Dexmedetomidine use for patients in palliative care with intractable pain and delirium: A retrospective study |
title | Dexmedetomidine use for patients in palliative care with intractable pain and delirium: A retrospective study |
title_full | Dexmedetomidine use for patients in palliative care with intractable pain and delirium: A retrospective study |
title_fullStr | Dexmedetomidine use for patients in palliative care with intractable pain and delirium: A retrospective study |
title_full_unstemmed | Dexmedetomidine use for patients in palliative care with intractable pain and delirium: A retrospective study |
title_short | Dexmedetomidine use for patients in palliative care with intractable pain and delirium: A retrospective study |
title_sort | dexmedetomidine use for patients in palliative care with intractable pain and delirium: a retrospective study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10530014/ https://www.ncbi.nlm.nih.gov/pubmed/37756303 http://dx.doi.org/10.1371/journal.pone.0292016 |
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