High-Flow Nasal Cannula Versus Conventional Oxygen Therapy in Relieving Dyspnea in Emergency Palliative Patients With Do-Not-Intubate Status: A Randomized Crossover Study

Abstract

Study objective: Palliative patients often visit the emergency department (ED) with respiratory distress during their end-of-life period. The goal of management is alleviating dyspnea and providing comfort. High-flow nasal cannula may be an alternative oxygen-delivering method for palliative patients with do-not-intubate status. We therefore aim to compare the efficacy of high-flow nasal cannula with conventional oxygen therapy in improving dyspnea of palliative patients with do-not-intubate status who have hypoxemic respiratory failure in the ED.Methods: This randomized, nonblinded, crossover study was conducted with 48 palliative patients aged 18 years or older with donot-intubate status who presented with hypoxemic respiratory failure to the

High-flow nasal cannula for acute hypoxemic respiratory failure in patients with COVID-19: systematic reviews of effectiveness and its risks of aerosolization, dispersion, and infection transmission

“…Full-text review of 38 potentially eligible studies identified 20 eligible studies. Of these, 17 were systematic reviews (SRs) 15,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] and three were RCTs [41][42][43] (Fig. 1).…”

“…Therefore, 12 RCTs with 1,989 patients were included in analyses, including nine RCTs from the original review and three RCTs from the updated search. [41][42][43][44][45][46][47][48][49][50][51][52] No trial directly evaluated HFNC in patients with COVID-19 or other coronavirus infections. Table 1 summarizes study characteristics.…”

“…Trials randomized between 14 and 776 patients; two used a crossover design. 43,52 Five trials were performed in the ICU, 45,46,48,50,52 six were performed in the emergency department (ED), [42][43][44]47,49,51 and one was performed in mixed ICU/ED settings. 41 One trial included patients with cardiogenic pulmonary edema only, 44 two included immunocompromised patients only, 45,46 and one included palliative patients only.…”

“…41 One trial included patients with cardiogenic pulmonary edema only, 44 two included immunocompromised patients only, 45,46 and one included palliative patients only. 43 Criteria for hypoxemia varied, including peripheral oxygen saturation (SpO 2 ) thresholds (primarily \ 90-95%), arterial partial pressure of oxygen (PaO 2 ) thresholds (\55-60 mmHg), P/F ratio (\300), or a combination of criteria including elevated respiratory rate (most commonly [ 22-25/min). All eligible studies initiated gas flows at 35 LÁmin -1 or higher in the HFNC group with one exception 42 that used initial flow rates of 19.5 to 30 LÁmin -1 ( Table 1).…”

Use of nasal high flow oxygen during acute respiratory failure

“…Compared to NIV for undifferentiated respiratory failure, there was no difference between NHF for any outcome in a single RCT [20]. In contrast, a small RCT in palliative patients with limitations on invasive ventilation found dyspnea was reduced with NHF compared to NIV [77]. NHF may have a role in some ED patients who would not be offered intubation or when NIV is not well tolerated.…”