The benefit of routine oxygen for terminally ill patients who are near death
This presentation is the property of its rightful owner.
Sponsored Links
1 / 18

The benefit of routine oxygen for terminally ill patients who are near death PowerPoint PPT Presentation


  • 50 Views
  • Uploaded on
  • Presentation posted in: General

The benefit of routine oxygen for terminally ill patients who are near death. Margaret L. Campbell, PhD, RN, FPCN Hossein Yarandi, PhD Wayne State University College of Nursing Detroit, MI. Oxygen benefits. Correct hypoxemia Reduce dyspnea Prolong life. Oxygen burdens.

Download Presentation

The benefit of routine oxygen for terminally ill patients who are near death

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


The benefit of routine oxygen for terminally ill patients who are near death

The benefit of routine oxygen for terminally ill patients who are near death

Margaret L. Campbell, PhD, RN, FPCN

Hossein Yarandi, PhD

Wayne State University College of Nursing

Detroit, MI


Oxygen benefits

Oxygen benefits

  • Correct hypoxemia

  • Reduce dyspnea

  • Prolong life


Oxygen burdens

Oxygen burdens

  • Decreased mobility

  • Nasal drying

    • Nosebleed

  • Feeling of suffocation

  • Prolongs dying

    • Extends caregiver days

    • Increases health care costs

  • Flammability risks


The benefit of routine oxygen administration for terminally ill patients who are near death

The benefit of routine oxygen administration for terminally ill patients who are near death

  • Aim – to determine the benefit of routine oxygen administration to terminally ill patients who are near death

  • Design – repeated measures, double – blinded, randomized cross-over, using the patient as his/her own control

  • Approval obtained from the Wayne State University IRB

  • Funding obtained from the Blue Cross Blue Shield of MI foundation


The benefit of routine oxygen administration for terminally ill patients who are near death1

The benefit of routine oxygen administration for terminally ill patients who are near death

  • Sample – patients who are near death and at risk of experiencing dyspnea

    • n = 32 (effect size 0.25, significance 0.05, power 0.80, correlation coefficient between measures 0.30)

    • Near death – Palliative Performance Scale ≤ 30

    • At risk for dyspnea but in no distress

      • COPD

      • Heart failure

      • Lung Cancer

      • Pneumonia


The benefit of routine oxygen administration for terminally ill patients who are near death2

The benefit of routine oxygen administration for terminally ill patients who are near death

  • Protocol

    • Obtain patient or family consent

    • Apply capnoline to patient’s nose and Y-connector to oxygen and air flow meters

    • Cover flow meters with bath towel

    • Randomly alternate oxygen, air, or no flow every 10 minutes until 6 encounters/patient

      • Data collector steps out of room for flow change


The benefit of routine oxygen administration for terminally ill patients who are near death3

The benefit of routine oxygen administration for terminally ill patients who are near death

Measures

Respiratory Distress Observation Scale (RDOS) score – range 0 – 16, high score signifies distress

Measured at baseline and 10 minutes after gas or flow change

Baseline RDOS ≤4

RDOS >4 during trial signified distress

SpO2

Et-CO2


Trial profile

Trial Profile

Palliative Care consults

n= 521

Eligible patients

n = 114

No consent, n = 73

Enrolled, n = 32

Declined, n = 9

Family unavailable for

in-person consent, n = 64


Results

Results

  • 27 (84%) had oxygen flowing at baseline

    • Reason for oxygen cannot be answered

  • 29/32 (91%) patients experienced no distress during the protocol

    • 3 patients were restored to baseline oxygen

  • 1 patient died during the protocol


Results1

Results

  • Average RDOS at baseline = 1.47 (0-4)

  • No differences in patient comfort were seen across gas and flow conditions

    (F = 0.55, p = 0.74, n = 29)


Results2

Results

  • Average SpO2 at baseline = 93.6 (69-100)

    • No statistically significant change over time

      (F = 1.97, p = 0.09, n = 26)

  • Some patients (n=12) received morphine in the 8 hours before the protocol (avg. 7.3 mg)

    • No relationship to baseline RDOS

      (Χ2 = 0.78, p = 0.94)


Limitations

Limitations

  • Missing SpO2 data for six patients

    • Hypothermia and/or hypotension

  • Incomplete blinding during “no flow” arm of protocol


Conclusions

Conclusions

  • Declining oxygen saturation is naturally occurring and expected

  • Declining oxygen saturation may predict but does not signify respiratory distress

  • The routine application of oxygen to most patients who are near death is not supported

  • An n of 1 trial of oxygen is appropriate in the face of respiratory distress


Acknowledgements

Acknowledgements

  • Hossein Yarandi, PhD

    • Statistician, WSU CON

  • Emily Dove-Medows, RN, MSN

    • Research Nurse, DRH

  • Judy Wheeler, RN, MSN, GNP

    • Palliative Care NP, DRH

  • Julie Walch, RN, MSN, FNP

    • Palliative Care NP, DRH

  • Denise Grabowski, RN, BSN

    • Angela Hospice


  • Login