Risk factors for serious adverse effects like overdose and mortality72
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Risk/benefit analysis to estimate LTOT effectiveness and further management: Patients on LTOT can be grouped into 3 broad effectiveness categories based on the risk/benefit balance with clear management strategies (see Figure 1):
  1. LTOT is effective (Adaptive LTOT dependence): LTOT is associated with discernible functional benefits, no high impact adverse effects (see box 4) have occurred, and the future risk of adverse effects is low. In this situation, LTOT can be continued as is but there should still be concrete planning with the patient about when and how LTOT will stop in the timeframe recommended above.
  2. LTOT is ineffective (Maladaptive LTOT dependence): LTOT is associated with no or minimal discernable functional benefits, high-impact adverse effects (see box 4) have occurred, and/or the future risk of adverse events is high. In this situation, LTOT must be modified to make it beneficial and/or safer.
  3. LTOT effectiveness questionable (Adaptive vs maladaptive LTOT dependence): LTOT is associated with some benefits and no high impact adverse events (see box 4) have occurred, but the future risk level is high. This group captures the set of patients that do not neatly fit into the above dichotomous LTOT effectiveness categories. The decision to continue LTOT as is or to modify LTOT regimen should be based on individual evaluation whether the benefits are sufficient and future risk levels are acceptable.
In all 3 categories of LTOT effectiveness, the healthiest long-term goal is a medically stable functional life without LTOT. Risk mitigation and collaboration between the provider and patient is also essential in 3 categories. LTOT reevaluation process is presented as a graphical flow chart in figure 1.