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A6761 - High Flow Nasal Cannula (HFNC) Oxygen Therapy as a Palliative Measure in End Stage Lung Disease (ESLD)
Author Block: D. Khateeb1, J. A. Mariglio2; 1Thomas Jefferson University Hospitals, Philadelphia, PA, United States, 2Tower Heath-Reading Hospital, West Reading, PA, United States.
High flow nasal cannula (HFNC) oxygen therapy is an innovative device capable of treating hypoxemic respiratory failure in patients unable to tolerate non-invasive ventilation (NIV) or with a do-not-intubate (DNI) status. HFNC delivers up to 100% humidified and heated oxygen at maximum flow rates of 60 L/min via nasal prongs improving oxygenation and relieving dyspnea by washout of pharyngeal dead space, reducing nasopharyngeal resistance, generating positive expiratory pressure, recruiting alveoli, and improving mucociliary clearance. End-stage-lung disease (ESLD) patients may develop profound hypoxemia and report significant dyspnea. We present the case of an ESLD patient discharged from the hospital to home hospice with HFNC oxygen therapy as a palliative measure.A 57 year-old woman was admitted with acute on chronic hypoxemic respiratory failure. She has a history of scleroderma related ESLD and WHO group I and III pulmonary hypertension (PH) with pulmonary veno-occlusive disease having previously failed advanced therapies and declined for lung transplant. She carried a DNI status. HFNC was initiated with 70% inspired oxygen delivered at 40L/min with improvement in her hyoxemia and subjective dyspnea. Empiric antibiotics were started for possible pneumonia and diuresis for volume overload. Palliative care consultation with the patient established her wish for discharge home on hospice. HFNC settings were weaned to 40% inspired oxygen delivered at 35 L/min. Through multidisciplinary efforts a home HFNC unit was obtained via self-pay arrangement and she was discharged home with hospice services.
Once only used inpatient, HFNC is now available for home use allowing ESLD patients with severe hypoxemia, dyspnea, and DNI status to remain or be discharged home. HFNC use in cancer patients has demonstrated improvement in dyspnea, oxygen saturation, and respiratory rate comparable to NIV. Standard oxygen therapies do not offer the same physiologic effects as HFNC. Compared to NIV, HFNC may offer benefits of improved tolerance, less skin breakdown, and allowing patients to communicate, eat, and drink easily. Careful communication and establishing clear treatment goals with patients and their families is important. While HFNC may provide enough support to prolong life by days or weeks, it should only be used as a palliative measure to provide comfort and alleviate suffering in the ESLD patient population. Home HFNC units may allow ESLD patients at the end-of-life to remain comfortable at home surrounded by family and friends. Further study is needed to validate the use of HFNC as a palliative measure in ESLD patients nearing the end-of-life.