margaret l. campbell, phd, rn, fpcn hossein yarandi, phd wayne state university college of nursing...
TRANSCRIPT
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Margaret L. Campbell, PhD, RN, FPCN Hossein Yarandi, PhD
Wayne State University College of NursingDetroit, MI
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Correct hypoxemia
Reduce dyspnea
Prolong life
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Decreased mobility Nasal drying
◦ Nosebleed Feeling of suffocation Prolongs dying
◦ Extends caregiver days◦ Increases health care costs
Flammability risks
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◦ 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
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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
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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
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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
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Palliative Care consultsn= 521
Eligible patientsn = 114
Enrolled, n = 32No consent, n = 73
Declined, n = 9 Family unavailable forin-person consent, n = 64
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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
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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)
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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)
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Missing SpO2 data for six patients◦ Hypothermia and/or hypotension
Incomplete blinding during “no flow” arm of protocol
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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
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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