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Continuing care describes the variety of health, personal, and social services provided over a prolonged period. The need for continuing care is increasing because people are living longer. Many people do not have families or others to care for them. Continuing care is mainly for patients who are disabled, functionally dependent, or suffering from a terminal disease. It is available within institutional settings or in homes. Examples include nursing centers or facilities, assisted living,...
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Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
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Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
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Sedatives and hypnotics encompass a wide range of substances, each with its unique mechanism of action, uses, and potential adverse effects.
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Palliative sedation outside a palliative care unit.

Sebastiano Mercadante1, Patrizia Villari2, Fabrizio David2

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Rapid transition to end-of-life care requires collaboration. Palliative sedation in intensive care settings can alleviate suffering, but requires clear communication with families about prognosis and treatment goals.

Keywords:
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Area of Science:

  • Medical Care
  • Palliative Care
  • End-of-Life Care

Background:

  • Intensive care settings present unique challenges for transitioning patients to end-of-life care.
  • Existing information on palliative sedation is primarily focused on traditional palliative care settings.
  • The need for acute transitions highlights gaps in current end-of-life care protocols.

Purpose of the Study:

  • To explore the complexities of palliative sedation and end-of-life transitions from intensive care.
  • To describe strategies for managing patient suffering during rapid end-of-life care decisions.
  • To emphasize the importance of interdisciplinary collaboration in end-of-life care.

Main Methods:

  • Case series describing four patients requiring rapid decision-making for symptom management.
  • Analysis of clinical pathways leading to intensive, non-beneficial treatments.
  • Focus on communication with families regarding prognosis and sedation.

Main Results:

  • Patients were transitioned to end-of-life care units despite varied clinical trajectories.
  • Open discussions with families about short prognosis and the need for palliative sedation were crucial.
  • Effective communication prevented prolonged suffering from intensive, non-beneficial treatments.

Conclusions:

  • Palliative care and end-of-life measures should extend beyond traditional settings.
  • Integration of palliative care principles into intensive care is essential.
  • Enhanced collaboration among healthcare professionals with diverse clinical backgrounds is vital for comprehensive end-of-life care.