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DN has described how the National Board of Health and Welfare guidelines on oxygen in palliative care for covid-19 patients were changed, after a query response was received stating that oxygen was lacking in nursing homes . From clearly advocating oxygen for shortness of breath and lack of oxygen, the recommendation became more vague: that oxygen can possibly be tested, but that oxygenation often does not need to be measured at the end of life, as the difficulty to breathe does not have to be due to a lack of oxygen.
In an article published in the European Respiratory Journal in July, the researchers asked 90 experts from 15 countries in palliative care and respiratory medicine, the majority of physicians and researchers, what recommendations they suggest should be given for palliative care of patients with covid-19. .
Among the 68 who responded A large majority, 9 out of 10, believe that oxygen therapy should be given as palliative care to patients with severe shortness of breath, if they have a lack of oxygen – a blood oxygen saturation below 90 percent. 57.4 percent gave a “strong recommendation” on this, while 32.4 percent recommended it under certain conditions.
The article links to several studies that provide support that oxygen can relieve. Some experts emphasize that oxygen deficiency needs to be addressed first, before focusing on alleviating shortness of breath, a symptom that can stem from several different causes.
One of the authors of the article en Magnus Ekström, associate professor at Lund University Hospital and leader of the research group in the department of dyspnea and chronic respiratory failure.
He is also one of the experts that was added after the National Board of Health and Welfare published its first version of the guide on palliative care for covid, after which the recommendation was changed. In Läkartidningen in April, he wrote together with a colleague: “Shortness of breath is relieved mainly by morphine” and “Oxygen can be administered on a trial basis without the need to measure saturation and removed if not relieved within an hour.”
– Oxygen is administered to avoid oxygen deficiency. It is deeply ingrained in us that oxygen should be given when oxygen starved, but in some cases it can be worse with oxygen and many times oxygen starvation does not really affect how the patient feels at the end of life, but there may be other measures that are more effective. This is difficult and controversial.
Do you have experience with patients with covidity at the end of life?
– No, we work very little with Covid. But this usually happens under different conditions. If oxygen does not help, it is important to take other palliative treatments. It can contribute to further suffering at the end of life by performing various measurements and monitoring and beeping devices, says Ekström.
However, support for palliative oxygen in oxygen deprivation is higher among international experts than support for the use of morphine preparations to relieve shortness of breath.
Do you think that international experts have less control over evidence and risks than you?
– No, I can’t say that. It’s always difficult to complicate questions when you ask them like this. But I think the answers match our way of looking at it quite well.
One of the co-authors of the European journal is British Anita K Simonds, professor of respiratory medicine, who points out that the evidence in the field is not great, since medical experiments in the final stages of life are difficult to perform. She believes that oxygen can definitely alleviate the symptoms of oxygen deficiency, no matter what the cause is, even if it doesn’t help everyone.
“In my opinion and according to most guidelines, oxygen can alleviate symptoms when you have an oxygen saturation below 90 percent, regardless of what is causing the oxygen deficiency.”
Simonds recommends that oxygen and saturation meters are available and that staff working with palliative care patients be trained by physicians to provide treatment.
Thomas Lindén, Head of Unit of the National Board of Health and Welfare considers that it is difficult to know how in the questions and answers of international experts what is understood by palliative care, if it really is about end-of-life care that the Board’s guideline deals with National Health and Welfare.
Thomas Lindén adheres to the recommendation that applies after the change:
– Our assessment is that if you are in the final stages of life and have the symptom of shortness of breath, then oxygen is not very important, but the symptoms are better relieved, for example, with opioids. Others may have a different opinion, but it is based on the experts we have consulted.
Is there a reason to review that recommendation?
– I think we have written a disclaimer or information that our recommendations have been made in a short time and that we can change them if new insights are added.
