High flow nasal cannula (HFNC) oxygen therapy is a system that allows the delivery of a higher than usual concentration of humidified oxygen (40–60 L/min of oxygen) through nasal cannulae. This is useful for patients with high oxygen demands as, unlike traditional non-invasive ventilation masks, there is less risk of skin breakdown and it allows patients to eat, drink and talk with caregivers and family members.1

There is little in the current literature about the use of HFNC therapy in inpatient hospice environments, where often the lack of bedside piped oxygen, and the need for multiple oxygen concentrators can increase complexity in its delivery.

Traditionally, palliative care has focused on incurable cancer. As the specialty shifts its focus to non-malignant conditions like end-stage pulmonary fibrosis it is important that we understand how HFNC therapy works and what challenges it may present in an inpatient hospice setting.

A 68-year-old woman with idiopathic pulmonary fibrosis was under the care of the transplantation team at her nearest cardiothoracic centre. She was seen in the pretransplantation clinic for assessment of lung transplant suitability. During this time her health deteriorated, and …