[High flow oxygen via nasal cannula: Palliative care and ethical considerations]

Abstract

High flow oxygen via nasal cannula (HFO₂NC) has become the first-line reference symptomatic treatment for hypoxemic acute respiratory failure. This non-invasive technique can be addressed, as palliative therapeutic care, to frail patients near end-of-life with a do-not-intubate order. A distinction will be made between those with an imminent and inevitable fatal outcome (pallitative end-of-life management) and those with hope for transient clinical remission (meliorative management). This review focuses on the expected physiological benefits and technical benefits/risks incurred by HFO₂NC use in this population. Its main purpose is to highlight the ethical principles governing the palliative management of patients in acute respiratory failure with a do-not-intubate order, and to discuss the various elements to be considered when defining the patient's palliative care plan, in a holistic, individual-centered approach.

Keywords: Acute respiratory failure; Do-not-intubate order; High flow oxygen via nasal cannula; Insuffisance respiratoire aiguë; Limitation thérapeutique; Oxygénothérapie à haut débit; Palliative care; Soins palliatifs; Treatment-limitation decision; À ne pas intuber.