Palliative Sedation Therapy in Pediatrics: An Algorithm and Clinical Practice Update
Palliative; Sedation
Cuviello A; Johnson LM; Morgan K; Anghelescu DL; Baker JN
Children
2022
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3390/children9121887" target="_blank" rel="noreferrer noopener">10.3390/children9121887</a>
Palliative Sedation Therapy Practice Comparison – A Survey of Pediatric Palliative Care and Pain Management Specialists
Dexmedetomidine; End of Life; Pain Management; Palliative Care; Palliative Sedation Therapy; Propofol; Symptom Management
Context: Palliative sedation therapy (PST) can relieve suffering at end-of-life (EOL) in children with intolerable and refractory symptoms. However, updated and consistent guidance on PST practices are imperative. Objectives: We investigate current variations in clinical practice and PST implementation among pediatric palliative care (PPC) and pain management (PM) specialists. Methods: We distributed an IRB-exempt electronic anonymous survey via email through the Society of Pediatric Pain Medicine, and the American Academy of Hospice and Palliative Medicine. Survey responses were collated and descriptively reported. Results: Of 83 survey responses, the majority (75%) represented large academic children’s hospitals. The distribution between PPC and pediatric pain management specialists’ responses was 60% and 40%, respectively. Most respondents reported having designated pain management and/or palliative care teams (70% and 90%, respectively). Approximately half (48%) reported following an institutional PST protocol, most not requiring formal ethics consult (69%). Only 54% of respondents noted that the Do Not Resuscitate (DNR) order was required prior to PST initiation. PST was primarily utilized for children with oncologic diagnoses (76%). The primary and secondary medications of choice for PST implementation were reported to be opioids (39%) and benzodiazepines (36%) by pain management specialists, and benzodiazepines (52%) and barbiturates (28%) by palliative care specialists. Conclusions: Our study highlights the variability in the practice and implementation of PST. Further educational efforts are key for establishing PST practices and efficient protocol development.
Cuviello A; Ang N; Morgan K; Baker JN; Anghelescu DL
American Journal of Hospice and Palliative Medicine®
2022
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/10499091221138298" target="_blank" rel="noreferrer noopener">10.1177/10499091221138298</a>
The COVID-19 Pandemic: Early Ripple Effects in Pediatric Palliative Care
pediatric; burnout; resilience; pediatric palliative care; Covid-19; SARS-CoV-2; global
Palliative care, which aims to provide comprehensive, interdisciplinary, holistic care to children, adolescents and adults with life-threatening, and ultimately life-limiting conditions, is a discipline that has emerged as an integral component of healthcare systems throughout the world. Although the value of life-affirming palliative care (PC) has been shown across many domains, funding and acceptance of palliative care teams have been variable: some hospital systems have free-standing, dedicated interdisciplinary teams while, in many instances, palliative care services are provided "pro bono" by individuals with a special interest in the discipline, who provide PC in addition to other responsibilities. In this article, we hope to highlight some of the observations on the early effects of the COVID-19 pandemic on the provision of PC in children.
Bustamante LM; Okhuysen-Cawley R; Downing J; Connor SR; Muckaden MA; Phillips M; Icaza A; Garzon N; Nakashima Y; Morgan K; Mauser D; Grunauer M
Children (Basel)
2022
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3390/children9050642" target="_blank" rel="noreferrer noopener">10.3390/children9050642</a>