Objectives 1. Identify the study aim. 2. Describe the study and its results. Background. Clinicians prescribe and administer oxygen to reports of dyspnea, in the face of dropping oxygen saturation, as a "routine" comfort intervention or to support anxious family members. Patients near death are often severely cognitively impaired or unconscious and may display no signs of distress even in the face of naturally occurring hypoxemia. Oxygen may produce nasal irritation, prolong dying and caregiving days, and increase the cost of care. Research objectives. To determine the benefit of administering oxygen to patients who are near death. Method. A double-blinded, repeated measures observation with the patient as his/her own control is underway. The Respiratory Distress Observation Scale (RDOS) 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 with patients who were near death (Palliative Performance Scale (PPS)-30%), at risk for respiratory distress, and with no distress at testing. Each patient had two encounters under each condition yielding six encounters per patient. Result. Twenty-six of 40 targeted patients have been tested. Patients were 62% female, 42% white and 58% African-American, and age 60- 97 years. Patients had heart failure (26%), chronic obstructive pulmonary disease (38%), pneumonia (38%), or lung cancer (8%). The average PPS was 18.8 +/- 0.9%. An internal consistency coefficient (a = 0.85) for RDOS was achieved. Repeated measures analysis of variance revealed no differences in respiratory comfort under changing gas and flow conditions. Oxygen saturation (SpO2) changed significantly across gas conditions (p = .046). Significance was found in the relationship of SpO2 to PPS (p = .04). Conclusion. Declining oxygen saturation is expected, naturally occurring, and does not signify respiratory distress. The n-of-1 trial of oxygen in clinical practice is appropriate in the face of respiratory distress. Implications for research, policy, or practice. The routine application of oxygen to patients who are near death is not supported.
Campbell, M., & Yarandi, H. (2012). The Benefit of Routine Oxygen Administration for Terminally Ill Patients Who Are Near Death (311-A). Journal of Pain and Symptom Management, 43(2), 336–337. https://doi.org/10.1016/j.jpainsymman.2011.12.041