End-Stage O2 Research

[MarcusKspn]

Hello all you hospice nurses,

I had a question for you all. We had a patient who passed away last night, he was on hospice services for the last 2 weeks. His O2 sats were dropping and we called hospice to see if they wanted us to increase his O2, he was getting 3L/m by N/C. Hospice told us no, that O2 only prolongs death. They were also talking to family about discontinuing the O2 all together, D/T prolonging death. I always thought O2 would be a comfort measure, so I'm trying to find some research about O2 therapy in end-stages. Do you know of any research supporting hospices claim? I'm open to new ideas, so I am interested in whats out there. I know research changes things, like the new hydration research. I appreciate any input.

Thank you.

[fab4fan]

I was just reading some research on this today...of course, got caught up in other stuff, so I can't recall it right now, but I will look into it tomorrow, if that would help.

If the pt was not uncomfortable, I probably would not have done anything with the O2. Really, what good will it do, ultimately? If the pt was uncomf., that would be a different story, but again, there are other measures that you can use to help with dyspnea besides O2. Depending on the terminal process, upping the O2 really won't do anything except make the caregivers less anxious.

[KatrinkaRN]

I've been working in hospice for 3 years now...I've learned to not use pulse ox's...instead I go by how my patient presents...if oxygen makes him comfortable by all means use it...but if the patient is actively dying and appears dyspneic I more than likely would medicate with morphine than increase the oxygen. Morphine is excellent in relieving dyspnea.

[Mazzi]

O2 use for an actively dying pt could be more distressing if a COPD. emphysema, ect, pt. The old adage "If your not going to be able to change the outcome with a test, why do the test?" applies to O2 sats. Look at your pt. Is he/she comfortable? if yes your are doing the right thing. If he/she looks umcomfortable, then try something else. Morphine is grest for dsypnea. Our Doc will usually give us RN's an order for O2 but feel it is for the RN's comfort more than for the Pt. You can tell if O2 helps the family feel like they are helping the Pt. As long as it will not be harmful to the Pt. why not give it? O2 does not prolong death. (unless you want to quibble over an hour or two. Comfort measures!!! Look at your Pt!!

[eagleriver]

It's possible that additional oxygen can cause a patient to stop breathing. If the patient has used oxygen before, has emphysema or something else that has their blood gasses messed up, their system may be attuned to oxygen demand, rather than C02, like those without breathing problems. We actually breathe to get rid of CO2, which results in additional oxygen supply to the RBCs. If our body responds to oxygen instead of CO2, increased levels of oxygen signal the body to stop breathing. That's why oxygen is virtually never set above 2.5L.

[cargal]

Our acting medical director today addressed a family wish for over 6L for a dying elderly man. The MD stated that MSO4 is the best choice, as someone above stated. He stated that a pulse ox would determine hypoxia verses dyspnea. My thoughts are that cellular death prohibit intake and use of O2 and H2O and nutrients also.

See https://allnurses.com/t12171.html and

https://allnurses.com/t12171.html

for a couple excellent articles, thanks to aimee and nursekaren