Palliative use of midazolam in acute geriatric units: a multicenter ambispective study

Abstract

Abstract Introduction End-of-life management in acute geriatric units (AGUs) is frequent but complex. Midazolam is the drug of choice for the management of refractory symptoms (particularly in the context of sedation) at the end of life. The objective of the present ambispective analysis was to investigate the frequency and modalities of midazolam use for palliative care in AGUs in France. Methods We conducted a prospective study in four AGUs in France, in order to identify patients having received comfort care only and having been treated with midazolam. We then retrospectively documented the modalities of midazolam use, the indications, and the level of effectiveness. Results Of the 210 patients identified as having received comfort care only in the AGU, 68 (32.4% (95%CI, 26.1 to 39.2%)) had received midazolam. The indication for midazolam corresponded to sedation in 67.6% of cases. The modalities of midazolam use at the end -of -life were rarely personalized, with low dose levels (less than 0.5 mg/h), mainly subcutaneous administration, and little anticipatory prescribing or dose level titration. The modalities did not appear to vary with the indication (anxiolysis vs. sedation). Discussion The present study is one of the first to have described the frequency and characteristics of palliative midazolam use in the AGU. Our results showed that the end-of-life use of midazolam is rarely personalized, not explicitly documented, and often not compliant with the current guidelines on palliative sedation practices. Clinical trials registration number NCT02949635. Registration Date: 2016-09-07.

Keywords

• Midazolam
• Geriatrics
• End-of-life care
• Deep sedations
• Anti-anxiety agents
• Palliative care