END STAGE LUNG CANCER AND CORRECT AMOUNT OF OXYGEN??? - 1253048

It's possible that cancer and/or other lung disease can leave so little functioning lung that adding oxygen even at high levels won't give adequate relief of the sensation of air hunger, also known as dyspnea (pronounced DISP-nee-ah). We usually look at a person's "oxygen saturation", measured by an oximeter placed on a person's fingertip or earlobe, to determine whether their lungs are getting enough oxygen. If the number is over about 88%, that should be a pretty good amount, though sometimes people will feel short of breath despite having a very good "O2 sat" of 95%, for instance. If so, adding more oxygen won't help -- people can be short of breath even if their lungs are getting enough oxygen.

It is possible for people to get too much oxygen. People with COPD can have a decrease in their respiratory drive from more supplemental oxygen than needed.

Four to 6 liters of oxygen/minute is the most that is readily given in a home setting. There are some "high-flow" oxygen set-ups in hospitals that can give 30-40 liters/minute, but those aren't portable and can only be done in the hospital, often only in an ICU setting.

Good luck.

-Dr. West

Hi Pamela, I'm so sorry about this. I have asked a palliative care doctor to respond with any input she may have. I hope you have gotten your person comfortable.

Janine

Thank you for your very kind words about GRACE. I'm very gratified that we could provide helpful information and support for you.

The pulmonologist is really the person best equipped to oversee the oxygen administration for a person, and I really can't make specific suggestions for your situation -- it is far more appropriate to speak to one or more of the individual doctors involved.

It is absolutely feasible to have a patient self-administer morphine through a patient-controlled analgesia (PCA) pump to help with shortness of breath, potentially to be combined with a fixed "basal" rate of morphine given per hour to a person for pain and/or air hunger. It's true that the opioids can decrease the "respiratory drive", but that doesn't mean it isn't appropriate to give them. Morphine can be extremely helpful in alleviating the symptom of air hunger, and even if it does decrease the respiratory drive some, I think that if a person is at a point where they are really suffering with shortness of breath and they can't be readily relieved with other measures, it's very unfortunate to withhold something that can relieve suffering. Withholding medications that can relieve pain and suffering may be done as a misguided effort to prolong survival, but usually at that point the main thing this achieves is prolonging the process of dying, and less comfortably than we could otherwise do.

-Dr. West

Is this patient on hospice? If you have someone coming in to help with meds, they can also help with oxygen. As a family member, if you're trying to do this on your own, it can be very hard and hospice not only helps the patient, but also the family. Take care, Judy

I'm so sorry for what you and this patient is going through. It is difficult to put an absolute number for a patient's oxygen, as this will depend on what the focus of care is. If care is focused on comfort, sometimes the number is not as helpful and it is more important to adjust treatment--oxygen, morphine or other opioids, lorazepam (ativan)--based on whether it makes the patient more comfortable. More oxygen does not always mean more comfort, as a patient may have a high oxygen number (the O2 saturation), but still feel quite short of breath.

Judy mentioned hospice, and I would just add that hospice has expertise in the management of a person's comfort and shortness of breath at this stage. They can help with real-time decisions on oxygen and medications to help with this.

-Dr. Harman

Dr Harman.. (Stephanie Harman, MD
Medical Director, Palliative Care Program) and any other doctors in related fields PLZ help me fastttt i want to ask it be found END STAGE LUNG CANCER AND CORRECT AMOUNT OF OXYGEN??? with ABG report of blood sample taken just after 5 min of patient removed from the artificial oxygen supply... if u can tell me how much LPM of oxygen patient need aprox that will be so kind of u.. dear .. latest ABG report i am mentioning now ...

Baro 717.1mm hg

pH 7.392
P02 49.0mm Hg
PCO2 44.7mm Hg
cHCO3 26.6 mmol/L
BE 1.2 mmol/L
SO2 (c) 84.1%
Hct 22.2%

Hi poorav,

I'm sorry, but for practical as well as legal reasons that kind of specific recommendation cannot be made by the GRACE faculty. Only the doctors directly involved in a patient's care can determine this.

JimC
Forum moderator