Abstract
Context
High flow nasal cannula (HFNC) is frequently used to manage dyspnea in patients with
cancer near the end of life. Because HFNC is restricted to the in-patient setting,
patients on HFNC need to be liberated from it to be discharged from the hospital.
Objectives
The purpose of this study is to assess the rate of successful liberation from HFNC
in a palliative and supportive care unit (PSCU).
Methods
The study is a retrospective chart review of all 374 adult patients with cancer on
HFNC admitted to a palliative and supportive care unit at a tertiary medical center
from January 1, 2018 to December 31, 2020. We determined the proportion of patients
who were liberated from HFNC (by day three and overall) and the proportion of patients
discharged alive.
Results
The mean age of the patients was 64, 54% were male and 73% were white. Only 16% (95%
CI: 13–20) of the patients were discharged alive. Liberation from HFNC by day three
and overall was accomplished in 23% and 25% of the patients respectively. Comparing
the patients who could be liberated from HFNC vs. those who could not by day three,
38% vs. 9% were discharged alive respectively; and overall, 62% vs. 1% respectively
(P < 0.001 in both cases).
Conclusion
Only a minority of patients with cancer at the end of life can be liberated from HFNC,
and only a minority are discharged alive. This information is important when discussing
goals of care with patients and their families before initiating HFNC.
Key Words
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Article info
Publication history
Published online: January 13, 2023
Accepted:
December 27,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
P. S. B. and A. A. contributed equally to this paper as co-first authors.
Identification
Copyright
© 2023 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
