High-flow nasal oxygen for breathlessness in palliative care

Ricard, 2020Ruangsomboon, 2020

High-flow nasal oxygen delivers high flow of warm, humidified gas in a range of oxygen concentrations, and helps wash out carbon dioxide and decrease respiratory effort. Compared with conventional oxygen therapy, high-flow nasal oxygen may decrease breathlessness severity in those with hypoxaemic respiratory failure. It may also be suitable for patients with mild hypercapnic respiratory failure who are not suitable for, or who cannot tolerate noninvasive ventilation. Recent studies suggest patients with palliative care needs may prefer high-flow nasal oxygen to conventional oxygen therapy because of the warmed air, respiratory support and maintenance of upper airway functions (eg speech, swallowing, cough).

When starting high-flow nasal oxygen for breathlessness in palliative care, consider the potential benefits, burdens and availability of treatment, and the patient’s prognosis, preferences and goals of care.

A simple guide for commencing high-flow nasal oxygen in the palliative care setting is to:

• set the initial high-flow nasal cannula flow rate at 35 L/min and adjust to between 30 and 60 L/min to improve the patient’s comfort and respiratory effort
• adjust the oxygen concentration to achieve an SpO₂ between 92 to 96%, or between 88 to 92% if the patient is at risk of hypercapnia (see Patient groups at risk of hypercapnia in the Respiratory guidelines).