Palliative sedation outside a palliative care unit.

The need of acute transition from an intensive care setting to an end-of-life setting requires collaboration and experience. Variable information exists on palliative sedation in traditional palliative care settings, including home care, hospices or palliative care units. Four cases which required a rapid decision-making to alleviate suffering in patients close to death are described. Despite having different clinical pathways leading to intensive but medically non-beneficial treatments, patients were converted to a rapid transition of care in the unit where they had been admitted, due to different logistic reasons. An appropriate discussion with relatives about the short prognosis and the need to sedate for controlling suffering in the last hours of life was fundamental in preventing further suffering with intensive treatments. These clinical notes suggest that palliative care and end-of-life measures should be also expanded in other settings, where palliative care issues are traditionally not properly assessed, implementing the collaboration with other colleagues with different clinical extractions.

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Competing interests: None declared.