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Letter to the Editor
High-flow oxygen therapy in palliative care: A reality in a near future?
M. Carqueijó
Pulmonology/Medicine Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
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            "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">A&#44; Axial contrast-enhanced CT image &#40;mediastinal window&#41;&#44; obtained 5 years after the left upper lobectomy&#44; shows a patent left superior pulmonary vein stump &#40;arrow&#41;&#46; B&#44; Axial contrast-enhanced CT image &#40;mediastinal window&#41;&#44; obtained 7 years after the left upper lobectomy&#44; shows a filling defect within the left superior pulmonary vein stump &#40;arrow&#41;&#46; C&#44; Axial fused PET&#47;CT image &#40;obtained 3 days after B&#41; demonstrates lack of FDG uptake at the level of the left superior pulmonary vein stump &#40;arrow&#41;&#44; suggesting a non-tumor thrombus&#46; D&#44; Axial contrast-enhanced CT image &#40;mediastinal window&#41;&#44; obtained 3 months after B&#44; shows resolution of the left superior pulmonary vein stump thrombus &#40;arrow&#41;&#46;</p>"
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    "titulo" => "High-flow oxygen therapy in palliative care&#58; A reality in a near future&#63;"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001a" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003a"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Dear Editor</span></span></span><p id="para0001" class="elsevierStylePara elsevierViewall">Duarte&#44; et al&#46; in the article review &#8220;High flow oxygen therapy in palliative care&#58; A reality in a near future&#63;&#8221; argue that High Flow Oxygen &#40;HFO&#41; is a reasonable palliative treatment in end-of-life patients&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> This is a fact and I also share their opinion&#44; since it makes it possible for people to communicate and feed themselves without an increased physical effort&#46;</p><p id="para0002" class="elsevierStylePara elsevierViewall">The authors also mention that this type of oxygen therapy has the benefit of producing fewer skin lesions&#46; From my experience&#44; it is true that it does not cause pressure ulcers&#44; especially on the nasal bridge &#40;even with the application of protective padding&#41; and the whole feeling of claustrophobia&#44;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> as is often the case with non-invasive ventilation &#40;NIV&#41;&#46; However&#44; HFO causes internal injuries in the nasal septum and a tamponing sensation with continued and prolonged use&#46; There are visible effects reported by patients undergoing HFO in the pneumology service where I work&#46; I emphasize that when this happens&#44; patients remove the nasal cannula for a moment and try to clean it to diminish this nasal tamponade sensation&#44; which eventually results in epistaxis&#46; I should add that we always prefer a nasal catheter that is silicone-coated and as rigid as possible&#44; in order to provide the best comfort for the patient&#46;</p><p id="para0003" class="elsevierStylePara elsevierViewall">I think it&#39;s important to analyze the benefits and drawbacks of this type of oxygen therapy recently used because&#44; despite all the benefits it has&#44; it is translates into discomfort&#46; In the authors opinion&#44; HFO is a reasonable palliative treatment in end-of-life patients&#44; however this ends up being counterproductive since it cause injury and&#44; consecutively&#44; suffering in patients&#46;</p><p id="para0004" class="elsevierStylePara elsevierViewall">For end of life patients I do not believe&#44; in most cases&#44; it is the best option&#44; and there is also no evidence that it has advantages over opioids and anxiolytics&#46; As the authors says&#44; dyspnea is the most prevalent symptom&#44; and can be quite debilitating at all levels&#46; The most important thing is the symptomatic relief of dyspnea&#44; emphasizing that the use of oxygen therapy does not represent an improvement in survival in people with advanced disease&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a></p><p id="para0005" class="elsevierStylePara elsevierViewall">There is still an urgent need to look at the person suffering from an incurable disease in advanced and&#47;or progressive stages&#44; in order to promote well-being and quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> Prevention and relief of pain are indispensable&#44; not the removal of one type of pain in order to offer another&#46; Symptomatic treatment continues to make more sense than inappropriate and excessive use of oxygen therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a></p></span></span>"
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ISSN: 25310437
Original language: English
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Pulmonology

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