title: Use of a high-flow oxygen delivery system in a critically ill patient with dementia.
abstract: We used a high-flow nasal cannula with a patient who required a high fraction of inspired oxygen but could not tolerate a nasal or facial mask. We saw a 92-year-old woman with delirium and dementia in the intensive care unit for multi-lobar pneumonia with severe hypoxemia. Attempts to oxygenate the patient failed because she was unable to tolerate various facial and nasal masks. We then tried a high-flow nasal cannula (Vapotherm 2000i), which she tolerated well, and she had marked improvement in gas exchange and quality of life. The patient had severe health-care-associated pneumonia, accompanied by delirium and hypoxemia. It became apparent that the patient's death was imminent, and the goal of therapy was palliative. She had previously clearly expressed a desire not to undergo intubation and mechanical ventilation. In a situation where the patient was agitated and unable to tolerate a mask, the high-flow cannula reduced her agitation and improved her dyspnea, oxygenation, tolerance of oxygen therapy, and comfort at the end of life. Oxygen via high-flow cannula may enhance quality of life by reducing hypoxemia in patients who are unable to tolerate a mask but need a high oxygen concentration.
authors.affiliation: Internal Medicine Department, Brooke Army Medical Center, 3851 Roger Brooke Drive, Fort Sam, Houston, TX 78234, USA. tatjana.calvano@amedd.army.mil
authors.forename: Tatjana P
authors.initials: TP
authors.lastname: Calvano
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Sill
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Kemp
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Chung
mesh_terms: D000369:Aged, 80 and over; D002404:Catheterization / Q000295:instrumentation*; D016638:Critical Illness; D003704:Dementia / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D010102:Oxygen Inhalation Therapy / Q000295:instrumentation*; D011014:Pneumonia / Q000150:complications / Q000523:psychology* / Q000628:therapy*