Margaret L. Campbell, PhD, RN, FPCN Hossein Yarandi, PhD

Wayne State University College of NursingDetroit, MI

Correct hypoxemia

Reduce dyspnea

Prolong life

Decreased mobility Nasal drying

◦ Nosebleed Feeling of suffocation Prolongs dying

◦ Extends caregiver days◦ Increases health care costs

Flammability risks

◦ 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

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

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

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

Palliative Care consultsn= 521

Eligible patientsn = 114

Enrolled, n = 32No consent, n = 73

Declined, n = 9 Family unavailable forin-person consent, n = 64

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

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)

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)

Missing SpO2 data for six patients◦ Hypothermia and/or hypotension

Incomplete blinding during “no flow” arm of protocol

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

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