75 Management of patients dying from end stage respiratory failure on ventilatory support, (high flow, heated humidified oxygen (HFNO) or bilevel positive airway pressure support (BiPAP)) outside the intensive care unit (ICU) in a district general ho

<h3>Introduction</h3> Looking back, before Covid, it was unusual to use HFNO outside ICU. It is now commonly used on respiratory wards to manage Type 1 Respiratory Failure (T1RF) alongside those on (BiPAP) for Type 2 Respiratory Failure (T2RF) with recent data showing mortality of up-to 35%.¹ Once dying is recognised, sedative medication is prescribed to allow a symptom controlled death alongside withdrawal of ventilatory support if appropriate. The palliative care and respiratory teams recognised that higher doses of drugs were required in T1RF. Looking forward, it is essential to have tailored guidelines to ensure good end of life care. <h3>Methods</h3> Data were collected on the Respiratory Ward on sequential patients from February 2023 to December 2024, requiring ventilatory support whilst treating a potentially reversible cause of a deterioration in their condition but subsequently died. Results were analysed to ascertain patient demographics, drugs used and the doses of sedation required. <h3>Results</h3> 18 patients requiring ventilatory support and needing sedative drugs for symptom control died. Aetiology of T1RF included, pulmonary fibrosis, pneumonitis, diffuse alveolar haemorrhage and metastatic lung cancer. Most of those with T2RF had COPD/obesity hypoventilation. T1RF (11patients) T2RF (7 patients) Mean age (yrs) 78.8 70.7 Midazolam CSCI 11 patients 7 patients Mean dose 69mg/24hrs mean dose 30 mg/24hrs Levomepromazine CSCI 5 patients 0 patients Mean dose 100mg Phenobarbitone CSCI 1 patient 0 patients Additional doses of sedative medication (midazolam/levomepromazine/phenobarbitone) 7/11 patients 1/7 patients Ventilatory support withdrawn 8/11 patients. 7/7 patients <h3>Conclusion</h3> Those dying with T1RF on HFNO need higher doses of sedatives to achieve symptom control whether that support is removed or not. This is likely due to high respiratory drive in these patients. Starting higher doses of sedation in dying T1RF patients is essential to avoid agitation/distress at the end of life and looking forward guidelines should reflect this. <h3>Reference</h3> British Thoracic Society. (2024). Respiratory Support Audit Executive Summary 2023. https://www.brit-thoracic.org.uk/quality-improvement/clinical-audit/national-respiratory-support-