2010 - Palliative oxygen and room air did not differ for relief of breathlessness in patients with refractory dyspnea

Rayner, Abi
February 2011
ACP Journal Club;2/21/2011, Vol. 154 Issue 2, p1
Academic Journal
Question In patients with life-limiting illness and refractory dyspnea, what is the effectiveness of oxygen compared with room air delivered by nasal cannula for relief of breathlessness? Methods Design Randomized controlled trial. ClinicalTrials.gov NCT00327873, Current Controlled Trials ISRCTN67448752. Allocation Concealed.* Blinding Blinded (patients, clinicians, and {clinical research nurses}†).* Follow-up period 7 days. Setting Outpatient pulmonary, oncology, and primary care clinics in Australia, USA, and the UK. Patients 239 patients é>18 years of age (mean age 74 y, 62% men) who had PaO[sub 2] é>7.3 kPa and refractory dyspnea related to life-limiting illness (>3 on Medical Research Council categorical dyspnea scale at rest or with negligible exertion), had received maximum treatment for underlying disease, were expected to survive for >1 month, and were receiving stable medications the previous week. Exclusion criteria were eligibility for long-term oxygen therapy; history of hypercarbic respiratory failure with oxygen; anemia, hypercarbia, or cognitive impairment; smoking; or respiratory or cardiac event in the past 7 days. Intervention 7 days of oxygen (n =>120) or room air (n =>119) delivered by a concentrator and nasal cannula at a continuous rate of 2 L/min. Patients were asked to use the concentrator for >15 h/d. Outcomes Main outcome was breathlessness right now (rating scale from 0 to 10, 10 = breathlessness as bad as you can imagine, assessed twice daily). Based on a sample size of 240, the study would have 80% power to detect a 1-point difference in breathlessness (α =>0.05). Patient follow-up 88% of patients completed all 7 days of assessments. Main results Oxygen and room air did not differ for morning or evening breathlessness (Table). Conclusion Oxygen and room air delivered by nasal cannula did not differ for relief of breathlessness in patients with life-limiting illness and refractory dyspnea.


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