For the critical outcomes of survival and therapeutic endpoints as measured by a composite of death, need for assisted ventilation, and respiratory failure, we identified very-low-quality evidence (downgraded for risk of bias, indirectness, and imprecision) from 1 retrospective observation study(Wijesinghe 2011, 618) enrolling 232 patients with acute exacerbation of chronic obstructive pulmonary disease showing no benefit from supplementary oxygen administration (odds ratio [OR], 1.4; 95% CI, 0.6–2.9).
For the important outcome of shortness of breath, we identified very-low-quality evidence (downgraded for inconsistency and serious indirectness) from 1 RCT(Bruera 1993, 13) enrolling 14 terminal cancer patients with dyspnea and hypoxemia showing benefit with supplementary oxygen administration (MD in visual analog scale score, −20.5; 95% CI, −27.6 to −13.5), and low-quality evidence (downgraded for inconsistency and indirectness) from 1 meta-analysis(Uronis 2008, 294) and 4 RCTs(Bruera 1993, 13; Booth 1996, 1515; Ahmedzai 2004, 366; Philip 2006, 541) enrolling 134 advanced cancer patients with dyspnea without hypoxemia who did not show benefit from supplementary oxygen administration (standardized MD, −0.09; 95% CI, −0.22 to 0.04, P=0.16).
For the important outcome of oxygen saturation, we identified moderate-quality evidence (downgraded for indirectness) from 3 RCTs, 1 enrolling 14 terminal cancer patients with dyspnea and hypoxemia(Bruera 1993, 13) (MD in oxygen saturation, 8.6%; 95% CI, 7.0–10.3), 1 enrolling 6 patients with dyspnea and hypoxemia(Booth 1996, 1515) (MD in oxygen saturation, 10.0%; 95% CI, 6.3–13.7) and 1 enrolling 51 advanced cancer patients with dyspnea(Philip 2006, 541) (mean increase in oxygen saturation, air 0.94% versus oxygen 5.43%; P |
No recommendation; the confidence in effect estimate is so low that the task force thinks a recommendation to change current practice is too speculative.
Values, Preferences, and Task Force Insights
In this review, the administration of supplementary oxygen was found to be of some benefit in the following specific circumstances:
• Advanced cancer patients who exhibit symptoms or signs of shortness of breath (dyspnea) and signs of hypoxia
• Individuals with decompression injury
The use of supplementary oxygen should be limited to individuals with specific training in oxygen administration.
Public commenting requested an oxygen saturation target for this review. We did not evaluate flow rates, but patients with hypoxemia in the included studies were provided supplementary oxygen that helped them reach normoxemia.
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