The oxygen mask is an iconic image culturally associated with intense medical scenes, something many of us assume is a necessity for a struggling patient’s survival. Is it, or is it just a handy prop used consistently in Grey’s Anatomy? For patients with hypoxia, oxygen can be lifesaving, but it can also be uncomfortable for a dying patient, a hindrance to crucial communication, or even potentially dangerous to a patient’s health.
In a 2013 study, medical air, oxygen, and room air were randomly alternated every ten minutes with patients who were near death and at risk for respiratory distress, and no change in respiratory comfort was observed in 91% of the patients. Oxygen then can been seen as a life sustaining treatment as well as have the potential to be a treatment of direct harm as well as an expensive wasted resource. However, while I would never presume to remove someone’s oxygen therapy without a doctor’s order, occasionally we need to remember that there might be potential downside to a treatment especially in the end of life care. So take a long deep breath, read the following blog post and remember that even with something as vital as oxygen therapy, there just might be more to the story.
Any treatment given without good reason can be harmful, and oxygen is no exception. Studies observe that patients routinely given high flow oxygen demonstrate the serious damage of hyperoxia, or too much oxygen. High concentration oxygen “washes out” nitrogen in adult lungs, which significantly impedes oxygen exchange, and in a compromised state, oxygen, which is also a free radical, cannot be fended off. Ultimately, supplemental oxygen reduces coronary blood flow and renders the vasodilators ALS providers use to treat chest pain ineffective. Also, high-flow oxygen dries out the nose and the throat and can cause the patient to choke.
Oxygen masks can make it difficult for healthcare providers to understand patients and for patients to properly express themselves. Added to this confusion and miscommunication is the fact that having a patient on oxygen can make it difficult for a physician to determine whether or not a patient is stable for discharge. A doctor assumes a patient is on oxygen because they are hypoxemic, so when they are not, it can make it difficult for them to assess the patient’s situation.
Many patients find oxygen masks suffocating, claustrophobic, and a barrier between them and their family. Nasal prongs can solve this problem to a degree, but the noise and invasiveness still affects quality of life, especially for those trying to find normalcy and comfort in their final days. A better option could be opiates in combination with non-invasive ventilation, which an Italy study determined to be more effective than oxygen therapy in patients with end-stage cancer.
Respiratory patterns change as a person approaches the end of their life. Individuals experience “air hunger,” and the automatic tendency has been to administer oxygen; however, if the patient suffered no respiratory problems before, oxygen might not help the situation, which can be difficult for families to understand. Breathlessness is a frightening and overwhelming experience, and often medication to soothe pain and anxiety are more effective. Oxygen administration has become part of “doing something” for a failing patient when the family and staff feel helpless, mistaking the signs of imminent death as discomfort. Though difficult, families need to come to terms with the dying process so as not to sacrifice their loved one’s comfort for their own.
Medical professionals and family members alike need to be aware of when oxygen therapy is necessary, and when it is not. Know how to identify unnecessary costs at the least, preventable death at the most. Lastly, while oxygen can certainly be considered a life sustaining treatment, it is not always of primary importance, especially during end of life care.
 Gorman, Linda M., “Is Oxygen Administration Necessary for the End-of-Life Patient?” The Oncology Nurse Community, April 8, 2014, http://www.theonc.org/author.asp?section_id=1778&doc_id=272653
 McEvoy, Mike, “Can oxygen hurt our patients?” BoundTree University, June 5, 2015, http://www.boundtreeuniversity.com/Clinical-Conditions/articles/1308955-Can-oxygen-hurt-our-patients
 Advanced life support
 Hanlon, Phyllis, “End-of-Life Oxygen Therapy: Rethinking a Commonly Used Treatment,” RT Magazine, June 7, 2013, http://www.rtmagazine.com/2013/06/end-of-life-oxygen-therapy-2/
 “Oxygen PRN For Comfort? Why Do Nurses Do It?” The Happy Hospitalist, 2010, http://thehappyhospitalist.blogspot.com/2010/11/oxygen-for-comfort-prn-why-do-nurses-do.html
 “Does oxygen usage prolong life or is it used for comfort care?” Canadian Virtual Hospice, n.d., http://www. virtualhospice.ca/en_US/Main+Site+Navigation/Home/For+Professionals/For+Professionals/Asked+and+Answered/Symptoms/Does+oxygen+usage+prolong+life+or+is+it+for+comfort+care_.aspx
 Hanlon, “End-of-Life Oxygen Therapy”
 Gorman, “Is Oxygen Administration Necessary”