Physicians must make therapeutic decisions daily based on scientific knowledge but also on their own conscience and sense of limits. Therapeutic adjustment is the decision not to implement or to discontinue a given treatment considered disproportionate, especially in end-of-life or irreversible clinical scenarios. In such situations, palliative care (PC) aims to prevent and relieve suffering in both patients and families, optimizing care throughout this process. To describe the therapeutic adjustments suggested by the PC team in cardiovascular patients with sepsis and/or septic shock. Retrospective descriptive study conducted by chart review of patients admitted with sepsis and/or septic shock who evolved with an indication for PC at the Instituto de Cardiologia de Santa Catarina between January and December 2024. Most PC consultations (63%, n=17) were requested in coronary care units (UCO), and only 37% (n=10) were requested in the ward. Regarding therapeutic adjustments suggested by the PC team, proportionality measures (do not resuscitate, and in case of cardiorespiratory arrest consider end of life) were recommended in 81% (n=22) of patients, and limitation of therapeutic effort in 96% (n=26). Among limitations of therapeutic effort, the main recommendations were: not starting a new antibiotic course (26%, n=7), reassessing ongoing antibiotic therapy (18%, n=5), discontinuing current antibiotics (11%, n=3), not performing invasive measures such as orotracheal intubation, mechanical ventilation and hemodialysis (70%, n=19), not referring to coronary care units (22%, n=6), not initiating or reassessing vasopressor use (59%, n=16), adjusting prescriptions (discontinuing capillary glucose testing and prophylactic anticoagulants) (15%, n=4), and not performing laboratory tests (26%, n=7). One patient did not receive PC recommendations because they died on the same day of the consultation. Family conferences to adjust expectations and provide guidance on PC were necessary in 52% (n=14) of cases. Implementing therapeutic adjustments in septic patients with an indication for palliative care is essential to reduce the risk of dysthanasia and to promote effective control of signs and symptoms in both patients and their families.
Colin et al. (2026) studied this question.