Developed by a consortium of specialist palliative care physicians in Wales, this Palliative Care Guideline was created to support frontline teams, and follows four steps to determine the patients ceiling of treatment, achieve sedation and alleviate symptoms, and if part of their end of life plan, wean from CPAP/NIV. This guidance is only intended for the specific situation of rapid deterioration over short time period (as short as 30-60 minutes) towards end of life and not for more gradual deterioration where a different approach to symptom control is required. Key recommendations:

• Determine the patient’s ceiling of treatment and priorities of care
• Administer medicines with the goal of care being to induce sedation and relieve agitation and distress over a short period of time (10-15 minutes)
• Remove CPAP or NIV as part of the end-of-life plan
• Maintain sedation using repeated doses of medication