Information: Review of the scienti c literature on palliative sedation, its clinical aspects and how to evaluate its effect. Articles published in: J Pain Symptom Manage 2021; 61
(4):831-844.e10 and Palliative Medicine 2021; 35 (2):295-314. Authors: ATLANTES research team, University of Navarra. European research group PalliativeSedation.
Infographic: Fundamentium. This project has received funding from the European Union´s Horizon 2020 research and innovation programme under grant agreement Nº 825700.
Pain
Delirium
Proportionality
Palliative sedation has to be
proportional to the relief of
intolerable suffering required in
each patient.
It can be:
• Light / Deep
• Intermittent / Continuous
When is it performed?
Palliative sedation is offered at the end of
life, when there is intolerable suffering
due to symptoms and/or severe distress
that are not otherwise suf ciently relieved.
Suffocation,
dyspnoea
Anticipation and aftercare
In advanced disease, at regular intervals, it is
good practice to nd out patients' care
preferences and talk with relatives regarding
treatment and palliative sedation. In addition,
the death of a loved one can cause a lot of
grief and aftercare is therefore important.
Suffering
Existentia
l suffering
What is it?
The level of consciousness of the
patient is reduced in order to relieve
intolerable suffering. Midazolam is an
example of medicine that is used.
Face
Calm
expression
Palliative Sedation practice
This medical practice does not intend to shorten life: death
happens naturally. Palliative sedation relieves patient´s intolerable
suffering at the end of life, which is a common concern.
Sedation Comfort
Physician
Nurse
Breathing
Slow and silent
Psychologist
Multi-disciplinary team
Spiritual
counselor
Voice
No negative
vocalizations
Team approach
It should only be started after consultation with a
team with specialist expertise in palliative sedation.
For complex patients, this team can advise the
treating team and help with follow-up.
Social
worker
How is it evaluated?
Once sedated, the wellbeing of the patient
is assessed by indicative signs of comfort
and consulting with relatives.
Body
Relaxed
Figure 1.2.1 Palliative sedation at the end of life
18
Conclusion
Changes in terminology reflect the various
issues surrounding the recognition of a
patient's overall suffering that have been
identified in the literature, the complexity of
determining the criterion of refractoriness,
the importance of the principle of
proportionality and the need to refine the
criteria for palliative sedation in terms of
duration and depth. This has been done to
develop a common language to facilitate
applicability and comparability.
English, Spanish, Basque, French, German,
Flemish, Hungarian, Italian, Dutch and
Romanian.
Download a copy of the full infographic in
the relevant country language or view an
animated version in each language at
https://www.palliativesedation.eu/workpackage-1/#
References
1. Arantzamendi M, Belar A, Payne S, Rijpstra
M, Preston N, Menten J, et al. Clinical Aspects
of Palliative Sedation in Prospective Studies.
A Systematic Review. J Pain Symptom
Manage. 2021;61(4):831-844.e10. doi:
10.1016/j.jpainsymman.2020.09.022