Weaning Heated High Flow Nasal Cannula at End of Life

Outcomes

1. Identify and manage common symptoms when patients on heated high flow nasal cannula approach end of life.

2. Develop strategies to create a culturally competent patient-centered interdisciplinary care plan for patients on heated high flow nasal cannula at end of life.

Key Message

Patients who elect to wean heated high flow nasal cannula at end of life often require intensive management of distressing symptoms including dyspnea and anxiety. We will review a stepwise approach to weaning heated high flow nasal cannula at end of life, including symptom management and implementation of culturally competent patient-centered interdisciplinary care plan.

Abstract

Heated high flow nasal cannula (HHFNC) allows patients to receive a high level of oxygen support while still being able to remain interactive (1). However, some patients don't recover enough lung function to leave an acute care setting and may elect withdrawal of oxygen support. Best practices for weaning HHFNC and managing symptoms in this setting have not been well studied (2).

Methods

We conducted a single-center retrospective chart review on 44 deceased patients who were weaned from HHFNC at a tertiary care medical center. All patients included received care by the inpatient palliative care team between January 2021 and May 2024. The primary objective of this study was to determine the median dosage of opioids and benzodiazepines used during HHFNC wean. Baseline characteristics, maximum HHFNC settings (flow rate and fraction of inspired oxygen) within 48 hours of the wean, opioid and benzodiazepine usage in the two days prior to the wean, time of wean initiation and termination, and cumulative amount of symptom management medications used to prevent and treat escalating dyspnea and anxiety were collected.

Results

Patients who elect to wean HHFNC at end-of-life often require intensive management of distressing symptoms including dyspnea and anxiety. We hypothesize that patients who have HHFNC weaned in a stepwise manner experience better symptom control than patients who have HHFNC stopped without a wean. We will share our stepwise approach to weaning HHFNC and the median doses of opioid and benzodiazepine medications used during HHFNC wean.

Conclusion

Patients who elect to wean HHFNC at end of life often require intensive management of distressing symptoms. We predict that a stepwise approach to weaning heated high flow nasal cannula and implementation of a culturally competent patient-centered interdisciplinary care plan are fundamental to ensuring high quality care.

References

1. Spoletini G, Alotaibi M, Blasi F, Hill NS. Heated humidified high-flow nasal oxygen in adults. Chest. 2015 Jul 1;148(1):253-61. 2. Kim MC, Lee YJ, Park JS, et al. Simultaneous reduction of flow and fraction of inspired oxygen (FiO2) versus reduction of flow first or FiO2 first in patients ready to be weaned from high-flow nasal cannula oxygen therapy: study protocol for a randomized controlled trial (SLOWH trial). Trials. 2020 Dec;21:1-7.