The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

HIGH FLOW OXYGEN THERAPY IN EARLY PALLIATIVE CARE.

Julien Legodec1, Guillume Lacroix2, Erwan Daranda2, Pierre Esnault2, Eric Meaudre2, Philippe Goutorbe2; 1Anesthesia and Intensive Care, military hospital Sainte Anne, Toulon, France; 2pulmonology, military hospital Sainte Anne, Toulon, France

Background High Flow Oxygen Therapy (HFO) is a very new process for acute respiratory failure’s treatment (ARF). HFO can bring up to patients 20 to 70 liters per minute with a adjustable fraction of delivered oxygen from 21 to 100%. This therapeutic is also attractive for its comfort (1). Approximately, 70% of patients afect by a cancer will present ARF (2). This patients, whose prognosis is less than 6 months, are not eligible in Intensive Care Unit (ICU). In the other hand, in France, they often require a conventional high concentration oxygen therapy by mask (HOM) with more frequent monitoring in a dedicated unit. We thought that these patients will take several benefit from this new process, particularly in term of comfort, communication and dyspnea. In this study, we compere HFO with conventional HOM in cancer patients whose present ARF. Method This is a pilot, prospective and cross over observational study. It was made in the Sainte Anne Military Hospital from Toulon, France. Patients with cancer, whose have early write a approach of non-ICU admission, and whose present an ARF, are screened. After consent, we assess some objective criteria (pulse oxymetry : SpO2 and respiratory rate : RR) and some subjective criteria (visual analog scale of dyspnea and communication, the palliative Edmonton Symptom Assessment System : ESAS), under convontional HOM and after 30 minutes of HFO using. For each patient, assessment was made by patient and/or family, by doctor and nurse. Results From June to December 2011, 10 patients were included in this study. SpO2 increase with the use of HFO (99.8% with HFO vs 93.6% with HOM, p < 0.0001). RR (breath/minute) decrease with the use of HFO (22.2 with HFO vs 27.8 with HOM, p < 0.001). For patients and/or families, the subjective assessment shows a significant improvement in 4 variables analyzed with the use of HFO. It was Dyspnea (5.1/10 with HFO vs 9/10 with HOM, p < 0.0001), Exchange and Communication (2.2/10 with HFO vs 7.2/10 with HOM, p < 0.0001), Well be (6.1/10 with HFO vs 8.2/10 with HOM, p < 0.0002) and Anxiety (4.5/10 with HFO vs 6.7/10 with HOM, p=0.0003). For Doctors and Nurses, the subjective assessment shows a significant improvement in the same 4 variables. Conclusion This study (10 patients) is completely innovanted. No work on HFO in palliative care is reported to date. (1,3). HFO improves the comfort of cancer patients whose present ARF and it mainly allows decrease valuable admission in care unit. Sponsored Research - None