DOI: 10.1097/CCM.0b013e31817c478f
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PMID: 18664822
Issn Print: 0090-3493
Publication Date: 2008/08/01
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Excerpt
Sprung et al. used empirical data to show that increasing dosages of opiates and benzodiazepines were associated with a shorter time to death. In their analysis, however, they do not correct for characteristics that are known to be related both to patient survival and medication use (type and dosage) such as, diagnosis and age of the patient, and previous history of opioid and benzodiazepine use. A causal relationship between medication dosage and time to death cannot be demonstrated without correcting for such factors. Therefore, the conclusion that is written in the editorial accompanying this article: “this study shows that larger doses of opioids and benzodiazepines led to shorter times before death” is debatable (2). In fact, there have been studies that specifically studied the effect of opioids and benzodiazepines at the end-of-life, which have shown that life is not shortened by these medications if they are titrated against pain and symptoms, not even when these medications are given in large or increasing dosages (3–7). These studies argue that, the worry should not be that death is hastened by medication to relieve pain and symptoms, but that physicians do not give enough medication to relieve pain and symptoms because of an unfounded fear to hasten the end-of-life of the patient.
Although these studies were not performed in the intensive care unit, they support the results of smaller studies that were performed in the intensive care unit that were referred to by Sprung et al. and in the editorial.
The authors have not disclosed any potential conflicts of interest.
