Compassionate Removal of Heated High-Flow Nasal Cannula for End of Life
- Resource Type
- Authors
- Stacy Fischer; Laura A. Foster; Andrea Forman; Hareklia Brackett
- Source
- Journal of Hospice & Palliative Nursing.
- Subject
- Male
medicine.medical_specialty
Palliative care
medicine.disease_cause
Tertiary referral hospital
03 medical and health sciences
0302 clinical medicine
Clinical Protocols
030502 gerontology
Fraction of inspired oxygen
Health care
medicine
Cannula
Humans
Weaning
Pandemics
Aged
Retrospective Studies
Aged, 80 and over
Advanced and Specialized Nursing
Community and Home Care
Terminal Care
Continuous Positive Airway Pressure
SARS-CoV-2
business.industry
COVID-19
Retrospective cohort study
Middle Aged
030220 oncology & carcinogenesis
Emergency medicine
Airway Extubation
Female
0305 other medical science
business
Ventilator Weaning
Nasal cannula
- Language
- ISSN
- 1522-2179
Patients often receive burdensome care at the end of life in the form of interventions that may need to be removed. Heated high-flow oxygen delivered through a nasal cannula (HHFNC) is one such intervention that can be delivered in the hospital yet is rarely available outside of this setting. During the COVID-19 (coronavirus disease 2019) pandemic, health care systems continue to face the possibility of rationing critical life-sustaining equipment that may include HHFNC. We present a clinical protocol designed for weaning HHFNC to allow a natural death and ensuring adequate symptom management throughout the process. This was a retrospective chart review of 8 patients seen by an inpatient palliative care service of an academic tertiary referral hospital who underwent terminal weaning of HHFNC using a structured protocol to manage dyspnea. Eight patients with diverse medical diagnoses, including COVID-19 pneumonia, underwent terminal weaning of HHFNC according to the clinical protocol with 4 down-titrations of approximately 25% for both fraction of inspired oxygen and liter flow with preemptive boluses of opioid and benzodiazepine. Clinical documentation supported good symptom control throughout the weaning process. This case series provides preliminary evidence that the clinical protocol proposed has the ability to ensure comfort through terminal weaning of HHFNC.