Nasal high flow therapy in palliative home care

Chronic hypoxemic respiratory insufficiency is likely to affect patients in need of palliative care, preventing these patients from being discharged to home care or from being transferred to hospice due to the standards of best supportive care. Whereas nasal high flow therapy (NHF) has proven an effective therapeutic option in hypoxemic respiratory failure, it is so fare rarely intensive or intermediate care units. NHF means nasal application of heated and humidified air oxygen mixture with a flow up to 60lpm containing a varying proportion of oxygen up to 90%, depending on the oxygen flow provided. We report two cases of successful NHF treatment in palliative home care situations with patients sufferingend stage lung disease and additionally from malignant tumor. On the one hand a 60 year old female patient with pulmonary fibrosis and functionally inoperable lung cancer. We established treatment with myAIRVO2 TM (Fisher & Peykel) with a flow of 20 lpm mixed with 12 lpm oxygen resulting in 70% FiO 2 . On the other hand a 70 year old male patient with severe precapillary pulmonary hypertension and colorectal cancer with hepatic metastases und pulmonary involvement. Similar to the first patient we started treatment with myAIRVO2 TM . However, in this case with 35 lpm flow and 53% FiO 2 , created by applying 15lpm oxygen. Both patients were able to return to and to stay at their private homes subsequently. NHF is a therapeutic option for chronic hypoxemic respiratory insufficiency in palliative home care. It enables patients to stay in their private homes and prevents extended hospitalization, with both factors significantly improving the quality of life for palliative patients.