Oxygen Is Nonbeneficial for Most Patients Who Are Near Death

• Published in: Journal of pain and symptom management Vol. 45; no. 3; pp. 517 - 523
• Main Authors: Campbell, Margaret L., PhD, RN, FPCN, Yarandi, Hossein, PhD, Dove-Medows, Emily, RN, MSN, CNM
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2013; Elsevier
• Subjects: Aged; Aged, 80 and over; Anesthesia & Perioperative Care; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Clinical death. Palliative care. Organ gift and preservation; Comfort; Comorbidity; Death; dying; dyspnea; Dyspnea - mortality; Dyspnea - nursing; Female; Humans; Incidence; Lung cancer; Male; Medical sciences; Michigan - epidemiology; Middle Aged; Oxygen; Oxygen Inhalation Therapy - utilization; Oxygen therapy; Pain Medicine; palliation; Palliative Care - utilization; Psychological distress; Respiratory disorders; respiratory distress; Respiratory Insufficiency - epidemiology; Respiratory Insufficiency - nursing; Risk Factors; Survival Analysis; Survival Rate; Terminal Care - utilization; terminal illness; Treatment Outcome; Unnecessary Procedures - utilization; Michigan; dyspnea; Oxygen therapy; palliation; dying; terminal illness; respiratory distress; Human; Oxygen; Respiratory disease; Mortality; Terminal stage; Palliative treatment; Cost benefit analysis; Dyspnea; Hypoxemia; Respiratory distress
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2012.02.012

Abstract Context Clinicians prescribe and administer oxygen in response to reports of dyspnea, in the face of dropping oxygen saturation, as a “routine” comfort intervention, or to support anxious family members. Oxygen may produce nasal irritation and increase the cost of care. Objectives To determine the benefit of administering oxygen to patients who are near death. Methods A double-blind, repeated-measure observation with the patient as his/her own control was conducted. The Respiratory Distress Observation Scale© measured presence and intensity of distress at baseline and at every gas or flow change. Medical air, oxygen, and no flow were randomly alternated every 10 minutes via nasal cannula with patients who were near death, at risk for respiratory distress, with no distress at the baseline of testing. Each patient had two encounters under each condition, yielding six encounters per patient. Results Patients were 66% female, 34% white, and 66% African American, and ages 56–97 years. Patients had heart failure (25%), chronic obstructive pulmonary disease (34%), pneumonia (41%), or lung cancer (9%). Most (91%) patients tolerated the protocol with no change in respiratory comfort. Three patients (9%) displayed distress and were restored to baseline oxygen; one patient died during the protocol while displaying no distress. Repeated-measure analysis of variance revealed no differences in the Respiratory Distress Observation Scale under changing gas and flow conditions. Conclusion The routine application of oxygen to patients who are near death is not supported. The n-of-1 trial of oxygen in clinical practice is appropriate in the face of hypoxemic respiratory distress.