Should dying patients be on oxygen?

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I have cared for many terminally ill patients over the years. One question that comes up frequently is should the dying patient be on oxygen at the end of life?

I see it from both sides, from hospice intake personnel as well as the admitting nurse — all had it drilled into them over the years that low oxygen saturation must be treated — to families who see how hospital and nursing home staff rush to put someone on oxygen because of low oxygen saturation.

Contrary to widespread belief, most dying patients do not need oxygen. Here’s why:

Hospice Focuses on the Patient, not the Numbers!

Hospice is about focusing on the needs of the patient, not trying to fix the numbers (lab values, vital signs, etc.). I’ve lost track of how many times over the years patients with low saturation and even those who are hyperventilating (respirations greater than 20) report they are either not short of breath at all or that they are ok where they are at with their shortness of breath.

Oxygen Does Not Bring Comfort

Many dying patients experience shortness of breath, but providing oxygen does not necessarily bring them comfort. In fact, for some patients, oxygen can be an irritant, leading to discomfort and agitation. Focus on what the patient determines to be comfortable, not the numbers.

Prolongation of Natural Death is Not a Patient/Family Goal

For many dying patients, the goal is not to prolong life but rather to ensure that their remaining time is spent in comfort and dignity. Providing oxygen may not contribute to this goal and may even hinder it by causing discomfort and distress.

Oxygen Use Does Not Add to Emotional Comfort

While oxygen may seem like a tangible way to provide comfort, the truth is that it often does not add to the emotional comfort of the patient, family, or staff. Instead, other interventions, such as pain management and emotional support, may be more effective in providing comfort and easing anxiety.

Other Interventions Can Provide Comfort

Rather than focusing on oxygen, there are other interventions that can be used to provide comfort to dying patients. These include:

• Pain management: Many dying patients experience pain and discomfort, which can be managed with medication, such as morphine.
• Emotional support: Dying patients and their families may experience anxiety, fear, and other difficult emotions. Providing emotional support through counseling, therapy, or other interventions can help ease these feelings.
• Spiritual support: Many dying patients find comfort in their faith or spiritual beliefs. Chaplains, clergy, or other spiritual leaders can provide support in this area.
• Practical support: Dying patients and their families may need assistance with practical tasks, such as meal preparation, housekeeping, and transportation. Providing support in these areas can help ease the burden and allow patients to focus on their remaining time.

When is Oxygen Necessary?

In my experience as a hospice nurse, oxygen may be necessary if the patient has lung disease including cancer or cancer that has metastases to the lungs, congestive heart failure, and leukemia. Over the years, I’ve found the general rule of thumb is that if the patient needed oxygen before they are terminal, they will continue to need oxygen while they are terminal. On the same token, if they did not need oxygen prior to becoming terminal, before adding the burden of oxygen (and I specifically do mean burden), the hospice nurse should discuss the issue with the patient and family.

Conclusion

As a hospice nurse, I know that the end of life can be a difficult and emotional time for patients and their families. While oxygen may seem like an obvious solution to address symptoms such as shortness of breath, it may not be the best option for all patients. Instead, other interventions, such as pain management, emotional support, and practical assistance, may be more effective in providing comfort and easing anxiety. Ultimately, the goal of end-of-life care should be to ensure that patients spend their remaining time in comfort and dignity, rather than focusing on prolonging life.

Resources

“Respondents also cited reasons that staff might not use oxygen for these patients: oxygen did not seem to bring comfort, oxygen was an irritant to patient, prolongation of natural death was not a patient/family goal, oxygen use did not add to the emotional comfort of patient/family/staff. Conclusion:” :=> https://pubmed.ncbi.nlm.nih.gov/29677408/

“Palliative oxygen is routinely prescribed at life’s end in response to patient reports of dyspnea, declining oxygen saturation, and signs of imminent death regardless of the patient’s ability to experience or report distress and/or in the absence of behaviors that signify respiratory distress.” :=> https://www.jpsmjournal.com/article/S0885-3924(12)00255-2/fulltext

“Dr. Pantilat said that for these patients, there is no evidence that supplemental oxygen provides any benefits.” :=> https://www.todayshospitalist.com/palliative-care-five-things-you-may-be-doing-wrong/

“Oxygen isn’t generally necessary for comfort… may prolong the dying process” :=> https://journals.lww.com/nursing/Citation/2005/02000/Taking_the_mask_off.45.aspx