title: Oxygen is nonbeneficial for most patients who are near death.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Office of Health Research, College of Nursing, Wayne State University, Detroit, MI 48202, USA. m.campbell@wayne.edu
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Campbell
authors.forename: Hossein
authors.initials: H
authors.lastname: Yarandi
authors.forename: Emily
authors.initials: E
authors.lastname: Dove-Medows
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004417:Dyspnea / Q000401:mortality* / Q000451:nursing*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000706:statistics & numerical data*; D010166:Palliative Care / Q000706:statistics & numerical data*; D012131:Respiratory Insufficiency / Q000453:epidemiology* / Q000451:nursing*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013727:Terminal Care / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D019564:Unnecessary Procedures / Q000706:statistics & numerical data