Article (Scientific journals)
Should we include monitors to improve assessment of awareness and pain in unconscious palliatively sedated patients? A case report
Six, Stefaan; Laureys, Steven; Poelaert, Jan et al.
2019In Palliative Medicine, 33 (6), p. 712-716
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Keywords :
Palliative care; patient monitoring; deep sedation; pain measurement; unconsciousness
Abstract :
[en] Background: Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question. Case presentation: A woman in her mid-80s was admitted to a palliative care unit, presenting with chronic lymphatic leukemia, depression, and a cerebrovascular accident, with right-sided hemiplegia and aphasia. The patient was unable to eat and was suffering from nausea and vomiting. Before admission, the patient had expressed her desire to discontinue treatment on several occasions. Case management: The decision was made to initiate palliative sedation. The patient consented to take part in a study to assess level of comfort and pain using two monitoring devices (NeuroSense monitor and Analgesia Nociception Index monitor). Case outcome: The patient died 90 h after initiation of palliative sedation. Titration of the medication was challenging and sedation was not deep enough during the first 2 days. Thirteen assessments made with the Ramsay Sedation Scale showed that the patient was considered to be in a deep sleep, while in fact the NeuroSense monitor indicated otherwise. Conclusion: This case demonstrates the feasibility and potential advantages of using monitoring devices to objectify assessments of pain and discomfort in palliatively sedated patients.
Disciplines :
Public health, health care sciences & services
Author, co-author :
Six, Stefaan ;  Université de Liège - ULiège > GIGA
Laureys, Steven  ;  Université de Liège - ULiège > Consciousness-Coma Science Group
Poelaert, Jan;  Vrije Universiteit Brussel - VUB > Anesthesiology & Perioperative Medicine
Bilsen, Johan;  Vrije Universiteit Brussel - VUB > Public Health > Mental Health and Wellbeing Research Group
Theuns, Peter;  Vrije Universiteit Brussel - VUB > Experimental & Applied Psychology
Musch, Liza;  Vrije Universiteit Brussel - VUB > Public Health > Mental Health and Wellbeing Research Group
Deschepper, Reginald;  Vrije Universiteit Brussel - VUB > Public Health > Mental Health and Wellbeing Research Group
Language :
English
Title :
Should we include monitors to improve assessment of awareness and pain in unconscious palliatively sedated patients? A case report
Publication date :
March 2019
Journal title :
Palliative Medicine
ISSN :
0269-2163
eISSN :
1477-030X
Publisher :
SAGE Publications, New York, United States - New York
Volume :
33
Issue :
6
Pages :
712-716
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 26 February 2020

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