High flow oxygen via nasal cannula: Palliative care and ethical considerations

• Published in: Revue des maladies respiratoires Vol. 39; no. 4; p. 367
• Main Authors: Lemyze, M, Dupré, C
• Format: Journal Article
• Language: English; French
• Published: France 01.04.2022
• Subjects: Oxygénothérapie à haut débit; Insuffisance respiratoire aiguë; High flow oxygen via nasal cannula; Soins palliatifs; Limitation thérapeutique; Palliative care; Acute respiratory failure; Treatment-limitation decision; À ne pas intuber; Do-not-intubate order
• ISSN: 1776-2588
• DOI: 10.1016/j.rmr.2022.02.061

High flow oxygen via nasal cannula (HFO NC) has become the first-line reference symptomatic treatment for hypoxemic acute respiratory failure. This non-invasive technique can be addressed, as palliative therapeutic care, to frail patients near end-of-life with a do-not-intubate order. A distinction will be made between those with an imminent and inevitable fatal outcome (pallitative end-of-life management) and those with hope for transient clinical remission (meliorative management). This review focuses on the expected physiological benefits and technical benefits/risks incurred by HFO NC use in this population. Its main purpose is to highlight the ethical principles governing the palliative management of patients in acute respiratory failure with a do-not-intubate order, and to discuss the various elements to be considered when defining the patient's palliative care plan, in a holistic, individual-centered approach.