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High-flow nasal OXYGEN therapy
  1. Sebastiano Mercadante,
  2. Claudio Adile,
  3. Patrizia Ferrera,
  4. Fausto Giuliana and
  5. Yasmine Grassi
  1. Main regional center of cancer pain and supportive/palliative care, La Maddalena Cancer Center, Palermo, Italy
  1. Correspondence to Dr Sebastiano Mercadante, La Maddalena Cancer center, Palermo 90146, Italy; terapiadeldolore{at}


Objective To report data of the use of high-flow nasal therapy (HFNT) in the palliative care setting.

Methods Five hypoxaemic patients were treated by HFNT in a 1-year period in a palliative care setting, either in the last days of life or as part of an intensive treatment for a reversible cause of hypoxic dyspnoea.

Results Four patients had a similar clinical pattern. After starting HFNT, dyspnoea intensity decreased and oxygen saturation improved, providing a clinical improvement for a duration of 2–3 days, but after 48–72 hours, their conditions deteriorated and patients underwent palliative sedation. Indeed, one patient with pulmonary embolism and pneumonia was treated by HFNT successfully and was discharged home 2 weeks after admission.

Conclusions HFNT may be helpful for severely hypoxaemic patients who are unresponsive to common measures adopted in the last weeks/days of life of patients with advanced cancer or to treat reversible conditions. The findings of this case series showed the ethical and psychological aspects of end of life, particularly for caregivers. Future studies should assess an early use of this device in combination with lower doses of opioids or as an alternative to their use.

  • Cancer
  • Lung
  • Hospital care
  • Hospice care
  • Dyspnoea
  • Terminal care

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  • Correction notice The article title has been corrected since it was first published.

  • Contributors SM: planning and reporting; CA, PF, FG and YG: conduct.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.