Continuous deep sedation in home palliative care units: case studies in the Florence area in 2000 and in 2003-2004.

AIM: The aim of this paper was to describe the frequency and the characteristics of continuous deep sedation in terminally ill patients. METHODS: All patients who died in home palliative care units in the Florence area between March 1-December 31, 2000 and July 1, 2003-June 30, 2004 were prospectively analysed with regard to social, demographic, and clinical characteristics. RESULTS: The data presented refer to 1075 patients (331 in 2000 and 744 in 2003-2004). Continuous deep sedation was applied in 14.2% and in 12% of patients, respectively. At baseline, patients who were sedated during the final stages of their life were more likely to be younger in age, to have poorer quality of life and better performance status. Such characteristics did not differ between the two periods. Hydration was not performed in 65% of all patients who finally received sedation in the period 2003-2004 versus 33% in those who did in 2000. In 2003-2004, the decision to use sedation was discussed with patients in 39% of those who were sedated. In 2003-2004, we noticed an increase in the use of benzodiazepines for continuous deep sedation from 43% to 87%. The increase in opioid average dosage from the onset of sedation until the last 24 h of their life was about seven-fold in 2000 and almost twice that amount in 2003-2004 in those patients who were not undergoing treatment with opioids when sedation started. CONCLUSION: The monitoring of end-of-life decision making and of medical practices involved in continuous deep sedation contributes to an enhancement in the quality of caring for terminally ill patients.