Background Interstitial Lung Disease (ILD) can have a rapidly progressive course with hypoxaemic respiratory failure, intolerable breathlessness and anxiety at end of life. Often, morphine and midazolam are administered via syringe pump to achieve symptom control with a degree of sedation. In the Acute Trust during the pandemic, High Flow Nasal Oxygen (HFNO) (Frat, Goudet, Girault. Rev Mal Respir. 2013;30:627–43) provided symptom relief even when the lungs were severely impaired. Prior to introduction of HFNO on IPU, the maximum oxygen that could be delivered was 15L via a non-rebreathing mask. The use of high flow rates via nasal cannula causes drying/bleeding of the nasal mucosa and the cold temperature is frequently intolerable.

Aim To introduce HFNO for use in a hospice to improve symptom control in patients dying from ILD when appropriate.

Methods A patient in the Acute Trust was transferred to the hospice for end of life care. Despite receiving 15L oxygen via a non-rebreathing mask, his oxygen saturations were below 80%. Any care triggered panic attacks and desaturation episodes down to 58%. His deterioration prior to transfer had been very rapid. He had been in hospital for 3 months. He found morphine helpful but did not tolerate benzodiazepines. The company supplying the HFNO system provided training to staff.

Results HFNO provided immediate relief with improved oxygenation, reduced respiratory rate, reduced anxiety and an ability to tolerate care. HFNO was well tolerated and the patient/family have spent quality time together. He is alive 3 months after transfer but is slowly/steadily deteriorating.

Conclusion HFNO is an effective way to provide symptom control in patients with end stage ILD, improving oxygenation and decreasing work of breathing and respiratory rate (Mauri, Turrini, Eronia, et al. Am J Respir Crit Care Med. 2017;195:1207–15; Vargas, Saint-Leger, Boyer, et al. Respir Care. 2015;60:1369–76). It is well tolerated (Cuquemelle, Pham, Papon, et al. Respir Care. 2012;57:1571–7) and its use has been pivotal in providing good end of life care for this patient. However it should be used judiciously and guidelines/indications for use should be developed.