High-flow nasal OXYGEN therapy

Abstract

ObjectiveTo report data of the use of high-flow nasal therapy (HFNT) in the palliative care setting.MethodsFive hypoxaemic patients were treated by HFNT in a 1-year period in a palliative care setting, either in the last days of life or as part of an intensive treatment for a reversible cause of hypoxic dyspnoea.ResultsFour patients had a similar clinical pattern. After starting HFNT, dyspnoea intensity decreased and oxygen saturation improved, providing a clinical improvement for a duration of 2–3 days, but after 48–72 hours, their conditions deteriorated and patients underwent palliative sedation. Indeed, one patient with pulmonary embolism and pneumonia was treated by HFNT successfully and was discharged home 2 weeks after admission.ConclusionsHFNT may be helpful for severely hypoxaemic patients who are unresponsive to common measures adopted in the last weeks/days of life of patients with advanced cancer or to treat reversible conditions. The findings of this case series showed the ethical and psychological aspects of end of life, particularly for caregivers. Future studies should assess an early use of this device in combination with lower doses of opioids or as an alternative to their use.

High-Flow Nasal Therapy Trends in Spain: A Survey-Based Perspective

“…From an evidence perspective, HFNT is proven to be an efficient and cost-effective therapy for patients with respiratory diseases, 4 , 5 , 6 , 7 , 8 which is commonly accepted by Spanish physicians as reported in our survey, with 63.2% of the responders acknowledging that they have considered prescribing HFNT. However, our questionnaire also demonstrated that this therapy remains under-prescribed by physicians, showing that administrative issues and lack of communication with the respiratory therapy service providers are the main barriers to the development of at home HFNT in Spain.…”

“…High-flow nasal therapy (HFNT) has been shown to be useful in the management of acute respiratory failure, and in chronic respiratory pathology such as stable COPD, 4 , 5 interstitial lung disease, 6 bronchiectasis, 7 and hypoxaemia in palliative care. 7 , 8 The use of HFNT at home is now recognize by the worldwide medical community and was proved to be cost-effective in patients with respiratory failure. 9 , 10 Moreover, two important clinical trials are currently ongoing in Europe to assess the reduction of the occurrence of a second exacerbation (HiFAE), 11 and to evaluate the effect of this therapy on hospital readmission or death (EPiC-HFT) 12 in COPD patients.…”