Compassionate Removal of Heated High-Flow Nasal Cannula for End of Life: Case Series and Protocol Development.

Szczegóły
Abstrakt

Tytuł:: Compassionate Removal of Heated High-Flow Nasal Cannula for End of Life: Case Series and Protocol Development.
Autorzy:: Brackett H
Forman A
Foster LA
Fischer SM
Źródło:: Journal of hospice and palliative nursing : JHPN : the official journal of the Hospice and Palliative Nurses Association [J Hosp Palliat Nurs] 2021 Aug 01; Vol. 23 (4), pp. 360-366.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Original Publication: Philadelphia, PA : Nursecom, Inc., c1999-
MeSH Terms:: Airway Extubation/*methods
Terminal Care/*organization & administration
Ventilator Weaning/*methods
Aged ; Aged, 80 and over ; Airway Extubation/nursing ; Airway Extubation/psychology ; COVID-19/epidemiology ; COVID-19/nursing ; Cannula/adverse effects ; Clinical Protocols ; Continuous Positive Airway Pressure/adverse effects ; Female ; Humans ; Male ; Middle Aged ; Pandemics ; Retrospective Studies ; SARS-CoV-2 ; Terminal Care/psychology ; Ventilator Weaning/nursing
References:: Nishimura M. High-flow nasal cannula oxygen therapy in adults: physiological benefits, indication, clinical benefits, and adverse effects. Respir Care . 2016;61(4):529–541.
Azoulay E, Lemiale V, Mokart D, et al. Effect of high-flow nasal oxygen vs standard oxygen on 28-day mortality in immunocompromised patients with acute respiratory failure: the HIGH randomized clinical trial. JAMA . 2018;320(20):2099–2107.
Spoletini G, Alotaibi M, Blasi F, Hill NS. Heated humidified high-flow nasal oxygen in adults mechanisms of action and clinical implications. Chest . 2015;148(1):253–261.
Pirret AM, Takerei SF, Matheson CL, et al. Nasal high flow oxygen therapy in the ward setting: a prospective observational study. Intensive Crit Care Nurs . 2017;42:127–134.
Mealer M, Moss M. Moral distress in ICU nurses. Intensive Care Med . 2016;42(10):1615–1617.
Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. JAMA . 2020;323(16):1545–1546.
Schunemann HJ, Khabsa J, Solo K, et al. Ventilation techniques and risk for transmission of coronavirus disease, including COVID-19: a living systematic review of multiple streams of evidence. Ann Intern Med . 2020;173(3):204–216.
Shah N, Mehta Z, Mehta Y. High-flow nasal cannula oxygen therapy in palliative care #330. J Palliat Med . 2017;20(6):679–680.
Hui J, Lohmann T, Orton K, Sinnarajah A. The use of heated humidified high flow oxygen therapy in the palliative setting: developing a practice support document for use in Calgary, Alberta. J Pain Symptom Manage . 2016;52(6):E105–E105.
Noome M, Beneken Genaamd Kolmer DM, van Leeuwen E, Dijkstra BM, Vloet LC. The nursing role during end-of-life care in the intensive care unit related to the interaction between patient, family and professional: an integrative review. Scand J Caring Sci . 2016;30(4):645–661.
Hansen L, Goodell TT, Dehaven J, Smith M. Nurses' perceptions of end-of-life care after multiple interventions for improvement. Am J Crit Care . 2009;18(3):263–271; quiz 272.
Ferrell B, Buller H, Paice J, Anderson W, Donesky D. End-of-life nursing and education consortium communication curriculum for interdisciplinary palliative care teams. J Palliat Med . 2019;22(9):1082–1091.
Price DM, Strodtman L, Montagnini M, et al. Palliative and end-of-life care education needs of nurses across inpatient care settings. J Contin Educ Nurs . 2017;48(7):329–336.
Truog RD, Campbell ML, Curtis JR, et al. Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American college [corrected] of critical care medicine. Crit Care Med . 2008;36(3):953–963.
Baier H, Begin R, Sackner MA. Effect of airway diameter, suction catheters, and the bronchofiberscope on airflow in endotracheal and tracheostomy tubes. Heart Lung . 1976;5(2):235–238.
Robert R, Le Gouge A, Kentish-Barnes N, et al. Terminal weaning or immediate extubation for withdrawing mechanical ventilation in critically ill patients (the ARREVE observational study). Intensive Care Med . 2017;43(12):1793–1807.
Campbell ML, Robert R, Reignier J. Discussion on terminal weaning or immediate extubation for withdrawing mechanical ventilation in critically ill patients (the ARREVE observational study). Intensive Care Med . 2018;44(2):275–276.
Childers JW, Back AL, Tulsky JA, Arnold RM. REMAP: a framework for goals of care conversations. J Oncol Pract . 2017;13(10):e844–e850.
Emanuel EJ, Persad G, Upshur R, et al. Fair allocation of scarce medical resources in the time of COVID-19. N Engl J Med . 2020;382(21):2049–2055.
Entry Date(s):: Date Created: 20210603 Date Completed: 20210713 Latest Revision: 20230822
Update Code:: 20240104
DOI:: 10.1097/NJH.0000000000000769
PMID:: 34081632
: Czasopismo naukowe

Patients often receive burdensome care at the end of life in the form of interventions that may need to be removed. Heated high-flow oxygen delivered through a nasal cannula (HHFNC) is one such intervention that can be delivered in the hospital yet is rarely available outside of this setting. During the COVID-19 (coronavirus disease 2019) pandemic, health care systems continue to face the possibility of rationing critical life-sustaining equipment that may include HHFNC. We present a clinical protocol designed for weaning HHFNC to allow a natural death and ensuring adequate symptom management throughout the process. This was a retrospective chart review of 8 patients seen by an inpatient palliative care service of an academic tertiary referral hospital who underwent terminal weaning of HHFNC using a structured protocol to manage dyspnea. Eight patients with diverse medical diagnoses, including COVID-19 pneumonia, underwent terminal weaning of HHFNC according to the clinical protocol with 4 down-titrations of approximately 25% for both fraction of inspired oxygen and liter flow with preemptive boluses of opioid and benzodiazepine. Clinical documentation supported good symptom control throughout the weaning process. This case series provides preliminary evidence that the clinical protocol proposed has the ability to ensure comfort through terminal weaning of HHFNC.
Competing Interests: The authors have no conflicts of interest to disclose.
(Copyright © 2021 by The Hospice and Palliative Nurses Association. All rights reserved.)

Informacja