Atención en la agonía

Abstract

Most terminally-ill patients pass through a phase of deterioration that precedes, by a few days, their death. Making the diagnosis of dying phase is key to ensuring that the patient and his or her family receives the best possible care and eventually experiences a good death. Care of the families should be a central activity of health teams in this phase. We should inform clearly of the situation, trying to anticipate symptoms and time, as well as circumstances, to death. We should encourage an active attitude of the family and adequate emotional support. Care plan should include non-pharmacological and pharmacological approach to achieve symptom control. Usually subcutaneous route is the best route to administrate drugs in this phase. Nutrition and fluids should not be offered to imminently dying patients unless it is considered likely that the benefit will outweigh the harm. Sometimes, when is no possible to relieve symptoms in the last days of life with available drugs, we can use palliative sedation therapy. Palliative sedation is defined as the use of specific sedative medications to relieve intolerable suffering from refractory symptoms by a reduction in patient consciousness. The indication of palliative sedation should follow systematic and inclusive processes that include ethical considerations, drug selection and monitoring of patients.