HIGH FLOW NASAL CANNULA AND HOSPICE AND PALLIATIVE CARE (HI-HOPEs)

Abstract

SESSION TITLE: Wednesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: High Flow nasal cannula (HFNC) is commonly used in patients with respiratory distress and hypoxemia. HFNC has been proposed as a palliative measure for managing breathlessness in patients near end of life who wish to forgo intubation. HFNC delivery in non-hospital settings is limited. Initiating HFNC may preclude patients from fulfilling wishes to die at home and may limit the use of hospice. METHODS: This is a retrospective chart review of all patients admitted to a large, urban academic medical center in 2016 who used HFNC. RESULTS: 286 patients with orders for HFNC were included. Patients were an average of 60.6 years old, >70% of patients were members of racial or ethnic minority groups, and 51.4% were male. Despite having a high risk of mortality (average age-adjusted Charleson Comorbidity Index = 5.8), only 34 (11.8%) had a DNR order during that admission and 47 (16.4%) received a palliative care consult. Length of stay was prolonged (mean = 23.2 days, median = 15.4 days). Hospital mortality rate was 23.4%. Less than half of patients (130, 45.5%) were discharged home. Few were referred for hospice (10, 3.5%) CONCLUSIONS: Although many patients were able to discharge home after initiating HFNC in the hospital, hospital mortality was high, and few received hospice or palliative care services. HFNC use limits discharge planning and choice of place of death as elected by patient. CLINICAL IMPLICATIONS: The use of HFNC may delay or limit the receipt of hospice and palliative care services. This finding should be further investigated and barriers to provision of HFNC in the home should be addressed to provide optimal care for patients at end of life. DISCLOSURES: No relevant relationships by Elizabeth Chuang, source=Web Response No relevant relationships by Nidhi Shah, source=Web Response