Type of publication:
Conference abstract
Author(s):
*Raton M.; *Rowe N.; *Wood G.;
Citation:
American Journal of Respiratory and Critical Care Medicine. Conference: American Thoracic Society International Conference, ATS 2025. San Francisco, CA United States. 211 (no pagination), 2025. Date of Publication: 01 May 2025.
Abstract:
Palliative patients often present to secondary care settings with respiratory distress during the endstage of their disease. Conventional oxygen therapy alongside opioid therapy has widely been considered the treatment of choice for dyspnoea and symptom alleviation. With an increasing number of palliative patients and the national drive for service improvement, the Respiratory Team have identified an additional method to enhance current practice. Based on previous positive experience gained since 2013 from utilising High Flow Oxygen Therapy (HFOT) during the acute stages of respiratory disease, it was decided to extend this therapy to patients with chronic disease and palliative needs. The physiological and clinical benefits of HFOT include reduction in dyspnoea and decreased work of breathing, augmentation of respiratory drive, improved quality of life, and comfort level in this patient population. During work on the COVID cohort ward (March 2020- Dec 2021) AIRVO2 was used routinely as a first-line treatment in over 300 patients and continued in over 70 patients in the palliation/ End of Life (EoL) pathway. Since then, AIRVO2 in combination with lowdose opioids has been used in Palliative/ EoL care routinely. In 2022 the first discharge from the hospital was facilitated to continue optimised treatment. Benefits from HFOT in EoL/ Palliative usage should be focused on comfort and symptom control with optimised FiO2 requirements. We looked at three patients who were discharged from hospital on HFOT: two patients to the hospice and one home. With the combined HTOT and conventional palliative management, we observed a significantly decreased requirement of opioid use, leading to a reduction in side effects such as drowsiness or palliative sedation. This enabled patients to experience interaction with family and friends at the end of their life. On each occasion, good feedback has been received from the family, hospice, and patients. Extending HTOT usage to the community enhances best interest care for individuals and avoids abrupt termination of therapy initiated in the hospital. This prevents palliative patients with symptomatic breathlessness from having to compromise on either place of death or symptomatic breathlessness. HFOT usage out of the hospital decreases the number of readmissions with the focus on extended care in the community. Discharging patients to the community requires a clear advanced care plan and close cooperation within Multidisciplinary Team. Correct patients' selection for discharge on HFOT needs to be considered due to the limited FiO2 concentration delivery in the community.
DOI: 10.1164/ajrccm.2025.211.Abstracts.A4177
