Oxygen therapy for breathlessness in the last days of life

In the last days of life, using pulse oximetry to titrate oxygen becomes unnecessary because target SpO₂ may become unachievable, and ongoing measurement can be counterproductive and cause anxiety. Reassure and educate family and carers that the goal of care at this time is comfort, and that monitoring and management of symptoms is the focus (rather than oxygen measurements). Oxygen can be trialled, or continued, as an adjunct to nonpharmacological therapies (eg fans) and pharmacological therapies—see Breathlessness causing distress in the last days of life.

Some patients, family and carers may feel reassured by the use of oxygen, while others feel restricted or burdened by it. While it is valuable to consider patient, family and carer perceptions of oxygen use, it is important that healthcare professionals do not ask family or carers to take responsibility for the decision to stop oxygen because they may feel responsible for the patient’s deathTiep, 2013. For general advice on decision-making around withdrawing or withholding treatment, see Withdrawing or withholding treatment in palliative care.

When death appears imminent and the patient is breathing comfortably, oxygen can be safely stopped without causing distress in more than 90% of patientsCampbell, 2013.