Sedación paliativa en la agonía realizada por un servicio de urgencias de Atención Primaria a nivel domiciliario. Estudio observacional retrospectivo / Palliative sedation in agony performed at home by a primary care emergency service. A retrospective study

Objetivos: El objetivo de este estudio fue conocer las características de la sedación paliativa en la agonía a nivel domiciliario realizada por personal no especializado en cuidados paliativos y detectar áreas de mejora. Material y método: Estudio observacional retrospectivo. Se incluyeron todos los pacientes falle- cidos en domicilio entre septiembre de 2020 y febrero de 2021, que precisaron sedación indicada por el Servicio de Urgencias de Atención Primaria (SUAP) Málaga. Resultados: El porcentaje de sedación paliativa fue del 16,4 % [9,8-23,2 %]. Solo el 36 % [27- 45 %] de los pacientes se encontraba incluido en el proceso de cuidados paliativos. En el 67,2 % [59-76 %] de los casos, eran crónicos no oncológicos. La disnea fue el síntoma más prevalente (76,1 % [68-83 %]). El delirium estuvo presente en el 21,4 % [13-28 %] de los pacientes. El fár- maco más utilizado fue el midazolam (94,9 % [91-99 %]). La media de tiempo que pasa desde el inicio de la sedación hasta el fallecimiento es de 24,3 h [19,3-29,2h]. Las diferencias en las medias de supervivencia entre hombres (20,765 [13,7-27,7]) y mujeres (29,2 [22,1-33,3]) fueron estadísticamente significativas. El 72 % [64 %-80 %] de los pacientes no recibió ningún tipo de seguimiento desde el inicio de la sedación hasta el fallecimiento. Conclusiones: Existe concordancia entre los resultados obtenidos en este trabajo y los encontra- dos en la bibliografía consultada, en cuanto a la proporción de pacientes con sedación paliativa en la agonía, tiempo de duración de la misma y principales fármacos empleados. La edad media de los pacientes fue mayor en este estudio, así como la prevalencia de patología crónica no oncológica y de disnea como principal síntoma refractario. Llama la atención el desconocimien- to del nivel de sedación de nuestros pacientes, la falta de seguimiento y la infrautilización de levomepromazina en delirium. (AU)

Objectives: The objective of this study was to assess the characteristics of at-home palliative sedation in agony as carried out by care providers who are not specialists in palliative care, and to detect areas for improvement. Material and method: A retrospective, observational study. All patients who died at home be- tween September 2020 and February 2021, who required sedation as indicated by the Primary Care Emergency Service (SUAP) in Malaga, were included. Results: The percentage of palliative sedation was 16.4 % [9.8 %-23.2 %]. Only 36 % [27 %-45 %] of the patients were included in the palliative care process. In 67.2 % [59 %-76 %] of cases, they had non-cancer chronic conditions. Dyspnea was the most prevalent symptom (76.1 % [68 %-83 %]). Delirium was present in 21.4 % [13 %-28 %] of patients. The most widely used drug was midazolam (94.9 % [91 %-99 %]). Mean time from start of sedation to death is 24.3h [19.3h- 29.2h]. The differences in mean survival rate between men 20.765 [13.7-27.7] and women 29.2 [22.1-33.3] were statistically significant; 72 %[64 %-80 %] of the patients did not undergo any follow-up from start of sedation to death. Conclusions: There is agreement between the results obtained in this study and those found in the consulted bibliography regarding the proportion of patients with palliative sedation in agony, its duration, and the main drugs used. The mean age of the patients was higher in this study, as well as the prevalence of non-oncological chronic disease, with dyspnea as the main refractory symptom. The perceived lack of knowledge regarding sedation levels in our patients, as wellas lack of follow-up and underuse of levomepromazine in delirium, are striking. (AU)

LINAC radiosurgery treatment for vestibular schwannoma / Tratamiento con radiocirugía micromultiláminas de schwannomas vestibulares

Objective: The aims of our study were to evaluate tumour response in a series of patients with vestibular schwannoma (VS) treated with linear accelerator stereotactic radiosurgery (LINAC-RS), to describe the complications and to analyze the variables associated with the response to treatment. Material and methods: This retrospective descriptive study included 64 patients treated from 2010 to 2016 with a minimum follow-up of one year, excluding patients with neurofibromatosis. Clinical-radiological parameters were evaluated. The treatment was performed using LINAC-RS. The prescribed dose was 12Gy at 90% isodose. Results: The mean age at treatment was 53 years, 56% were women. Ninety-eight percent of the patients had hearing loss, 71% with grade III according to the Gardner-Robertson Classification. The mean volume at treatment was 2.92cc and the mean follow-up, 40.95 months. The overall therapeutic success was 90%, reaching 100% at 12 and 24 months, and 86% after 36 months of follow-up. The radiological result was significantly related to the initial tumour volume (p<0.037). In 20 patients there was evidence of transient tumour growth compatible with pseudoprogression. Acute complications were present in 37.5%, and transitory complications in 50%. Chronic complications were found in 20%, with 84% being permanent. The rate of acute complications was lower in patients with regression (p<0.016). Chronic complications were more frequent in the 41-60 year old age group (p<0.040). Conclusions: In our study, the overall tumour control was in accordance with other published series. The radiological result significantly related to the tumour volume at the commencement of treatment. The rate of acute complications was lower in patients with regression

Objetivo: Los objetivos del estudio fueron evaluar la respuesta tumoral en una serie de pacientes con schwannoma vestibular (SV) tratados con radiocirugía (RC) mediante acelerador lineal de electrones (LINAC), describir las complicaciones y analizar las variables relacionadas con la respuesta al tratamiento. Material y métodos: Estudio descriptivo retrospectivo de 64 pacientes tratados entre 2010-2016 con seguimiento mínimo de un año, excluyendo pacientes con neurofibromatosis. Se evaluaron parámetros clínico-radiológicos. El tratamiento se realizó mediante RC-LINAC. La dosis prescrita fue de 12Gy al 90% de isodosis. Resultados: La edad media al tratamiento fue de 53 años, 56% mujeres. El 98% de los pacientes presentaban hipoacusia, el 71% grado iii según la clasificación Gardner-Robertson. El volumen medio al tratamiento fue de 2,92cc, y la media de seguimiento 40,95 meses. El éxito terapéutico global fue del 90% siendo del 100% a los 12 y 24 meses y del 86% a partir de los 36 meses de seguimiento. El resultado radiológico se relacionaba con el volumen tumoral inicial (p<0,037). En 20 pacientes se evidenció un crecimiento tumoral transitorio compatible con seudoprogresión. El 37,5% tuvieron complicaciones agudas siendo transitorias el 50%. Se recogieron complicaciones crónicas en el 20%, siendo permanentes en el 84%. La tasa de complicaciones agudas era menor en pacientes con regresión (p<0,016). Las complicaciones crónicas fueron más frecuentes en el grupo de 41-60 años (p<0,040). Conclusiones: En nuestra serie, el control tumoral global obtenido es acorde con otras series publicadas. El resultado radiológico estaba relacionado con el volumen tumoral inicial al tratamiento. La tasa de complicaciones agudas fue menor en pacientes con regresión

LINAC radiosurgery treatment for vestibular schwannoma.

OBJECTIVE: The aims of our study were to evaluate tumour response in a series of patients with vestibular schwannoma (VS) treated with linear accelerator stereotactic radiosurgery (LINAC-RS), to describe the complications and to analyze the variables associated with the response to treatment. MATERIAL AND METHODS: This retrospective descriptive study included 64 patients treated from 2010 to 2016 with a minimum follow-up of one year, excluding patients with neurofibromatosis. Clinical-radiological parameters were evaluated. The treatment was performed using LINAC-RS. The prescribed dose was 12Gy at 90% isodose. RESULTS: The mean age at treatment was 53 years, 56% were women. Ninety-eight percent of the patients had hearing loss, 71% with grade III according to the Gardner-Robertson Classification. The mean volume at treatment was 2.92cc and the mean follow-up, 40.95 months. The overall therapeutic success was 90%, reaching 100% at 12 and 24 months, and 86% after 36 months of follow-up. The radiological result was significantly related to the initial tumour volume (p<0.037). In 20 patients there was evidence of transient tumour growth compatible with pseudoprogression. Acute complications were present in 37.5%, and transitory complications in 50%. Chronic complications were found in 20%, with 84% being permanent. The rate of acute complications was lower in patients with regression (p<0.016). Chronic complications were more frequent in the 41-60 year old age group (p<0.040). CONCLUSIONS: In our study, the overall tumour control was in accordance with other published series. The radiological result significantly related to the tumour volume at the commencement of treatment. The rate of acute complications was lower in patients with regression.