Midazolam en la sedación paliativa de pacientes con cáncer al final de la vida

Dunia Morales Morgado, Iván Ramón Concepción, Jorge Luis Soriano García, Mayté Lima Pérez, Noyde Batista Albuerne, Vilma Fleites Calvo, Masiel González Meisozo, Maritza González Blanco

Texto completo:

PDF

Resumen

Introducción: La sedación paliativa (SP) permite el control de síntomas refractarios al final de la vida en pacientes con cáncer terminal.

Objetivo: Evaluar el uso de midazolam en pacientes con cáncer avanzado y síntomas refractarios.

Métodos: Se realizó un estudio retrospectivo y descriptivo de 141 pacientes en el Servicio de Oncología del Hospital "Hermanos Ameijeiras" (2007-2017). Criterios de inclusión: confirmación histológica de cáncer y síntomas refractarios en etapa terminal, edad ≥ 18 años, y expectativa de vida < 2 semanas. Se obtuvo el consentimiento informado. Las dosis, formas y vías de administración del midazolam fueron variables en dependencia de la severidad de los síntomas, experiencia del equipo médico, y preferencias de pacientes y/o familiares.

Resultados: Predominó el dolor con 31 pacientes (22 %), y el 42,5 % con dolor y delirio, como síntomas refractarios. El tiempo medio más corto para la sedación paliativa fue el delirio con 4,0 horas. La vía subcutánea fue la más empleada (46,8 %), y el 36,2 % de los pacientes tuvo un intervalo de hasta 24 horas de duración. La administración intravenosa continua permitió conseguir un tiempo medio para la sedación deseada más corto (6,6 horas). La sedación paliativa se realizó más frecuentemente en el hospital (73,0 %), que en la atención primaria.

Conclusiones: La sedación paliativa con midazolam tiene impacto en el control de los síntomas refractarios al final de la vida en pacientes con cáncer avanzado.

Palabras clave: sedación paliativa; síntoma refractario; cuidados paliativos; midazolam.

Referencias

Bibliografía

Siegel RL, Miller KD, Jemal A. Cancer statistics. CA: Cancer J Clin. 2019; 69: 7–34. http://dx.doi.org/10.21037/atm.2020.03.55.

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: Cancer J Clin. 2018; 68: 394-424. http://dx.doi.org/10.21037/atm.2020.03.55.

Anuario Estadístico de Cuba 2019. Edición 2020. MINSAP, Dirección Nacional de Registros Médicos y Estadísticas de Salud. La Habana, 2020. Versión electrónica disponible en: www.sld.cu ISSN: 1561-4433. Accedido: Abril 30, 2020.

Nipp RD, El-Jawahri A, Moran SM, D'Arpino SM, Johnson PC, Lage DE, et al. The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer. Cancer. 2017; 123: 4720-4727. http://dx.doi.org/10.1002/cncr.30912.

Xiao J, Chow KM, Liu Y, Chan CWH. Effects of dignity therapy on dignity, psychological well‐being, and quality of life among palliative care cancer patients: A systematic review and meta‐analysis. Psyco Oncology. 2019; 28 (9): 1791-1802. https://doi.org/10.1002/pon.5162.

Verkissen MN, Hjermstad MJ, Van Belle S, Kaasa S, Deliens L, Pardon K. Quality of life and symptom intensity over time in people with cancer receiving palliative care: Results from the international European Palliative Care Cancer Symptom Study. PLOS ONE. 2019; 14 (10): e0222988.

http://doi.org/10.1371/journal.pone.0222988.

Henson LA, Maddocks M, Evans C, Davidson M, Hicks S, Higginson IJ. Palliative care and the management of common distressing symptoms in advanced cancer: pain, breathlessness, nausea and vomiting, and fatigue. J Clin Oncol. 2020; 38 (9): 905-914. http://doi.org/10.1200/JCO.19.00470.

Heijltjes M, Thiel G, Rietjens J, der Heide A, Graeff A, Delden J. Changing practices in the use of continuous sedation at the end of life. A systematic review of the literature. J Pain Symptom Manage. 2020. Disponible en: https://doi.org/10.1016/j.jpainsymman.2020.06.019. Fecha de acceso: Junio 10, 2020.

Cherny NI, and ESMO Guidelines Working Group. ESMO Clinical Practice Guidelines for the management of refractory symptoms at the end of life and the use of palliative sedation. Ann Oncol. 2014; 25 (suppl 3): iii143–152. http://doi.org/10.1093/annonc/mdu238.

American College of Physicians. American College of Physicians Ethics Manual. Third edition. Ann Intern Med 1992; 117: 947–960.

https://doi.org/10.7326/0003-4819-117-11-947.

Maeda S, Morita T, Ikenaga M, Abo H, Kizawa Y, Tsuneto S. Changes in opinions on palliative sedation of palliative care specialists over 16 years and their effects on clinical practice. Support Care Cancer. 2019; 27 (6): 2211-2219. https://doi.org/10.1007/s00520-018-4497-2.

Palliative and end of life care Priority Setting Partnership (PeolcPSP). Putting patients, carers and clinicians at the heart of palliative and end of life care research. January 2015. Disponible en:

https://palliativecarepsp.files.wordpress.com/2015/01/peolcpsp_final_report.pdf Fecha de acceso: Junio 10, 2020.

Parliamentary and Health Service Ombudsman. Dying without dignity. 2015. https://www.ombudsman.org.uk/publications/dying-without-dignity-0. Fecha de acceso: Junio 10, 2020.

Prommer E. Midazolam: an essential palliative care drug. Palliative Care Social Practice. 2020; 14: 1 –12. https://doi.org/10.1177/2632352419895527.

Soriano JL, Lima M, Batista N, Febles R, Morales D. Midazolam en la sedación paliativa terminal de pacientes con cáncer. Rev Cubana Medicina. 2011; 50 (4): 359-375. Disponible en:

http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-75232011000400004. Fecha de acceso: Abril 30, 2020.

Pirovano M, Maltoni M, Nanni O, Marinari M, Indelli M, Zaninetta G, et al. A new palliative prognostic score: a first step for the staging of terminally ill cancer patients. Italian Multicenter and Study Group on Palliative Care. J Pain Symptom Manage. 1999; 17: 231-239.

https://doi.org/10.1016/S0885-3924(98)00145-6.

Ermacora P, Mazzer M, Isola M, Pascoletti G, Gregoraci G, Basile D, et al. Prognostic evaluation in palliative care: final results from a prospective cohort study. Support Care Cancer. 2019; 27: 2095-2102.

https://doi.org/10.1007/s00520-018-4463-z

Hunter J, Orlovic M. Institute for Public Policy Research. May 2018. Disponible en:

https://www.ippr.org/files/2018-05/end-of-life-care-in-england-may18.pdf. Fecha de Acceso: Abril 20, 2020.

Imai K, Morita T, Akechi T, Baba M, Yamaguchi T, Sumi H, et al. The principles of revised clinical guidelines about palliative sedation therapy of the Japanese Society for Palliative Medicine. J Palliat Med. 2020; Disponible en: https://doi.org/10.1089/jpm.2019.0626.

Butler C, Brigden C, Gage H, Williams P, Holdsworth L, Greene K, et al. Optimum hospice at home services for end-of-life care: protocol of a mixed methods study employing realist evaluation. BMJ Open. 2018; 8: e021192. https://doi.org/10.1136/ bmjopen-2017-021192.

Rodrigues P, Crokaert J, Gastmans C. Palliative sedation for existential suffering: a systematic review of argument-based ethics literature. J Pain Symptom Manage. 2018; 55: 1577-1590.

https://doi.org/10.1016/j.jpainsymman.2018.01.013.

Abarshi E, Rietjens J, Robijn L, Caraceni A, Payne S, Deliens L, et al. International variations in clinical practice guidelines for palliative sedation: a systematic review. BMJ Support Palliat Care. 2017; 7: 223-229.

https://doi.org/10.1136/bmjspcare-2016-001159.

Ziegler S, Schmid M, Bopp M, Bosshard G, Puhan MA. Continuous deep sedation until death - a swiss death certificate study. J Gen Intern Med. 2018; 33 (7): 1052-1059. https://doi.org/10.1007/s11606-018-4401-2.

Monreal-Carrillo E, Allende-Pérez S, Hui D, García-Salamanca MF, Bruera E, Verástegui E. Bispectral Index monitoring in cancer patients undergoing palliative sedation: a preliminary report. Support Care Cancer. 2017; 25: 3143-3149. https://doi.org/10.1007/s00520-017-3722-8.

Prado BL, Gomes DBD, Usón Júnior PLS, Taranto P, França MS, Eiger D, et al. Continuous palliative sedation for patients with advanced cancer at a tertiary care cancer center. BMC Palliative Care. 2018; 17 (1): 13.

https://doi.org/10.1186/s12904-017-0264-2.

Hui D. Benzodiazepines for agitation in patients with delirium: Selecting the right patient, right time and right indication. Curr Opin Support Palliat Care. 2018; 12 (4): 489-494. https://doi.org/10.1097/SPC.0000000000000395.

Hui D, Frisbee-Hume S, Wilson A, Dibaj SS, Nguyen T, De La Cruz M, et al. Effect of lorazepam with haloperidol vs haloperidol alone on agitated delirium in patients with advanced cancer receiving palliative care: A randomized clinical trial. JAMA. 2017; 318: 1047-1056.

https://doi.org/10.1001/jama.2017.11468.

Bodnar J. A review of agents for palliative sedation/continuous deep sedation: Pharmacology and practical applications. J Pain Palliat Care Pharmacother. 2017; 31:16-37. https://doi.org/10.1080/15360288.2017.1279502.

Agar MR, Lawlor PG, Quinn S, Draper B, Caplan GA, Rowett D, et al. Efficacy of oral risperidone, haloperidol, or placebo for symptoms of delirium among patients in palliative care: A randomized clinical trial. JAMA Intern Med. 2017; 177: 34-42. https://doi.org/10.1001/jamainternmed.2016.7491.

Hui D, Hess K, Dibaj SS, Arthur J, Dev R, Dalal S, et al. The minimal clinically important difference of the Richmond agitation-sedation scale in patients with cancer with agitated delirium. Cancer. 2018; 124: 2246-2252.

https://doi.org/10.1002/cncr.31312.

Kim YS, Song HN, Ahn JS, Koh SJ, Ji JH, Hwang IG, et al. Sedation for terminally ill cancer patients: A multicenter retrospective cohort study in South Korea. Medicine (Baltimore). 2019; 98 (5): e14278.

https://doi.org/10.1097/MD.0000000000014278.

Ziegler S, Merker H, Schmid M and Puhan MA. The impact of the inpatient practice of continuous deep sedation until death on healthcare professionals’ emotional wellbeing: a systematic review. BMC Palliat Care. 2017; 16 (1): 30. https://doi.org/10.1186/s12904-017-0205-0.

Shen HS, Chen SY, Cheung DST, Wang SY, Lee JJ, Lin CC. Differential family experience of palliative sedation therapy in specialised palliative or critical care units, J Pain Symptom Manage. 2018; 55 (6): 1531-1539.

https://doi.org/10.1016/j.jpainsymman.2018.02.007.

Lux MR, Protus BM, Kimbrel J, Grauer P. A survey of hospice and palliative care physicians regarding palliative sedation practices. Am J Hosp Palliat Care. 2017; 34: 217-222. https://doi.org/10.1177/1049909115615128.

Enlaces refback

  • No hay ningún enlace refback.




Copyright (c) 2020 Jorge Luis Soriano García

Licencia de Creative Commons
Este obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional.