Management of Dyspnea With High- Flow Nasal Therapy

Dyspnea in patients with incurable illness is a difficult symptom. Therefore, there is a need to identify new effective treatment modalities. Previous studies suggest that high-flow nasal therapy delivered via a nasal cannula (HFNT = High-Flow Nasal Therapy) may alleviate dyspnea, and similarly that directing airflow toward the face can provide relief. HFNT has been studied very little in hospice settings and on palliative care wards. The aim of this study is to determine whether HFNT is a feasible and effective treatment for relieving dyspnea in patients receiving palliative care. Patients will be recruited from the Hatanpää Palliative Care Ward and the Pirkanmaa Hospice, Tampere, Finland. The target is to recruit approximately 30-40 patients. The inclusion criteria are: age ≥18 years, ability to understand the study and provide informed consent to participate, a palliative treatment approach, and significant dyspnea. Each patient receives HFNT and fan therapy in which airflow will be directed toward the patient's face. Both treatments will last 30 minutes. Patient symptoms will be asked after the treatments. In addition, patients will be asked to rate the overall benefit they experienced from the intervention and any side effects. The primary endpoint is the relief of dyspnea with HFNT compared with fan therapy. The study will be conducted in accordance with laws, regulations, and guidelines governing medical research, as well as good scientific practice and research ethics. The study does not involve significant risks or measurements or sampling procedures that would cause additional discomfort. All other care for the patient will be provided according to the standard practices of the treating unit, and participation in the study will not limit any necessary treatments. Identifiable information will not be disclosed for use outside the research group. Results will be reported in a manner that does not allow patients to be identified. The Ethics Committee of the Wellbeing Services County of Pirkanmaa has approved the study. If successful, the study will significantly improve the care of the patients in palliative care.

Inclusion Criteria: * The patient is in palliative care (ICD-10 diagnostic code Z51.5 palliative care) * Age ≥ 18 years * Ability to understand the study and provide informed consent to participate * Significant breathlessness (NRS = Numeric Rating Scale ≥ 4). * The treating physician has assessed that the patient would not benefit from treatment in intensive care unit or monitor unit. * The treating physician has assessed that the patient would not benefit from invasive mechanical ventilation (intubation) or cardiopulmonary resuscitation. Exclusion Criteria: * Decreased level of consciousness, delirium, or other lack of cooperation that prevents participation. * Respiratory support other than HFNT is required. * The patient has received HFNT during the same admission to palliative care ward or hospice. * The cause of dyspnea can be treated immediately. * Inability to provide informed consent to participate.