End-of-life home care of an interstitial pneumonia patient supported by high-flow nasal cannula therapy: A case report

Home High-Flow Therapy in Patients with Chronic Respiratory Diseases: Physiological Rationale and Clinical Results

High-flow therapy (HFT) is the administration of gas flows above 15 L/min. It is a non-invasive respiratory support that delivers heated (up to 38 °C), humidified (100% Relative Humidity, RH; 44 mg H2O/L Absolute Humidity, AH), oxygen-enriched air when necessary, through a nasal cannula or a tracheostomy interface. Over the last few years, the use of HFT in critically ill hypoxemic adults has increased. Although the clinical benefit of home high-flow therapy (HHFT) remains unclear, some research findings would support the use of HHFT in chronic respiratory diseases. The aim of this review is to describe the HFT physiological principles and summarize the published clinical findings. Finally, we will discuss the differences between hospital and home implementation, as well as the various devices available for HHFT application.

High Flow Nasal Cannula in Patients With Cancer at the End of Life

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.

IPF Respiratory Symptoms Management — Current Evidence

Idiopathic pulmonary fibrosis (IPF) is a progressive, chronic disease of the lungs which is characterized by heavy symptom burden, especially in the last year of life. Despite recently established anti-fibrotic treatment IPF prognosis is one of the worst among interstitial lung diseases. In this review available evidence regarding pharmacological and non-pharmacological management of the main IPF symptoms, dyspnea and cough, is presented.

Analysis of the influencing factors of the clinical effect of respiratory humidifier in treating AIDS complicated with severe Pneumocystis jiroveci pneumonia

OBJECTIVE

To analyze the factors influencing the clinical effect of using respiratory humidifier in patients with AIDS complicated with severe Pneumocystis jiroveci pneumonia (PCP).

METHODS

According to the treatment results, AIDS patients with severe PCP were divided into two groups, successful group (n=68) and failure group (n=94), to compare the early ventilation changes between the two groups.

RESULTS

The ICU ratio of the successful group was lower than that of the failure group (P<0.05). The respiratory frequency, heart rate, PaO₂, C-reactive protein and SOFA score of the successful group were lower than those in the failure group (P<0.05), while SpO₂, FiO₂, PaO₂/FiO₂, SpO₂/FiO₂, Rox index and IL-10 levels were increased in the successful group (P<0.05). The successful group had higher IL-6 and IL-1β level than that of the failure group. The levels of IL-8 were decreased (P<0.05). The success of respiratory humidifier was negatively correlated with the score of SOFA (P<0.05).

CONCLUSION

The clinical effect of respiratory humidifier in the treatment of AIDS patients with severe PCP was related to PaO₂/FiO₂, PaO₂, ROX index, SOFA score, and IL-6 and IL-8 levels.