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Published guidelines on palliative sedation lack applicability and evidence with regard to the choice of pharmacological agent, and to appropriate outcomes parameters. To respect proportionality, the intended depth of palliative sedation should be based on individual's will and expectations. The depth of sedation needs to be considered in combination with the other criteria of effectiveness, reversibility and safety of this procedure. Considerations when selecting the most appropriate pharmacological sedative agents and their route of administration should be decided with the patient, and based on patient characteristics that may compromise sedatives' effectiveness and the setting of care. The majority of recommendations suggest midazolam as the drug of first choice for palliative sedation. Delayed or ineffective palliative sedation remains an issue that has been less explored than life-shortening, abuse and misuse risks related to this procedure. Intravenous anesthetics such as propofol appear to be the best alternatives in case of midazolam sedation failure. [ABSTRACT FROM AUTHOR]

Patient-Controlled Analgesia (PCA) involving the use of on-demand subcutaneous or intravenous opioids offers patients greater autonomy in managing pain. In palliative situations, this method allows a continuous background infusion rate of opioids and allows a patient to self-administer a pre-set bolus dose of opioids. Indications for PCA are moderate to severe pain that is not relieved by 3rd level analgesics administered in oral ore transdermal route or by intermittent injections. PCA prescription, programming, initiation, and safety monitoring require the vigilance of a trained interdisciplinary team. PCA is safe and effective on hospice inpatients and outpatients and encourage their return or their stay at home., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêt en relation avec cet article.

Cachexia increases the risk of therapeutic failure and reduces the quality of life for cancer patients. Patients with nutritional risks should be referred to a dietitian. Nutritional interventions primarily include meal adaptation and oral nutritional supplements. When cachexia is more severe, artificial nutrition is indicated for patients with a KPS (Karnofsky Performance Status) of 40 or above and a life expectancy of more than 6 weeks. When the digestive system is functional, enteral nutrition is recommended. Parenteral nutrition shows the same benefits but requires close monitoring. The decision to stop artificial nutrition is influenced by the medical condition, the patient's wishes, and the socio-cultural context., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article

Pain and opioids use have different meanings depending on one's beliefs. It is important to encourage and to recognize the value of religious practices as a part of holistic care. Respecting spirituality has the potential to strengthen the therapeutic alliance and promote appropriate care. This article provides food for thought through clinical vignettes frequently encountered in clinical practice., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

During the COVID-19 pandemic, many of the usual aspects of therapeutic withdrawals had to be adapted. Preparing and supporting patients, next of kin and staff to death was particularly challenging. Palliative care was integrated into the process of therapeutic withdrawals in intensive care units during this crisis. Continuing education related to end-of-life issues and defining collaboration with palliative care is essential for intensive care teams., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.