High-Flow Nasal Cannula for DNR-DNI Palliative Patients

Written by Clay Smith

Spoon Feed
High-flow nasal cannula (HFNC) is an effective way to relieve dyspnea in hypoxic palliative care patients who do not wish to be intubated.



Why does this matter?
Air hunger is a terrible form of suffering in patients with terminal disease. Intubation is not a solution for most palliative care patients. Supplemental oxygen can relieve the sense of dyspnea as can morphine and sometimes benzodiazepines. What about HFNC?

Stop the air hunger
This was a RCT with 44 adult palliative care patients with hypoxia and do-not-intubate status. They were randomized to routine nasal cannula (NC) then crossed over to HFNC or vice versa. An objective dyspnea score (modified Borg scale) was significantly improved with HFNC vs. traditional NC. Also, dyspnea (on a numeric scale of 0 to 10), respiratory rate, and morphine dose in the first hour were all lower when on HFNC compared to regular NC. Flow rate for HFNC ranged from 34-37L/min. This is a helpful way to relieve the suffering of dyspnea in our palliative care patients and is more effective than NC.

Source
High-Flow Nasal Cannula Versus Conventional Oxygen Therapy in Relieving Dyspnea in Emergency Palliative Patients With Do-Not-Intubate Status: A Randomized Crossover Study. Ann Emerg Med. 2020 May;75(5):615-626. doi: 10.1016/j.annemergmed.2019.09.009. Epub 2019 Dec 19.

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