High-Flow Oxygen and Bilevel Positive Airway Pressure for Persistent Dyspnea in Patients With Advanced Cancer: A Phase II Randomized Trial

Abstract

Context Dyspnea is one of the most distressing symptoms for cancer patients. The role of high flow oxygen (HFO) and bilevel positive airway pressure (BiPAP) in the palliation of dyspnea has not been well characterized. Objectives To determine the feasibility of conducting a randomized trial of HFO and BiPAP in cancer patients, and to examine the changes in dyspnea, physiologic parameters and adverse effects with these modalities. Methods In this randomized study (ClinicalTrials.gov Identifier: NCT01518140), we assigned hospitalized patients with advanced cancer and persistent dyspnea to either HFO or BiPAP for two hours. We assessed dyspnea with a numeric rating scale (NRS) and modified Borg scale (MBS) before and after the intervention. We also documented vital signs, transcutaneous carbon dioxide and adverse effects. Results Thirty patients were enrolled (1:1 ratio) and 23 (77%) completed the assigned intervention. HFO was associated with improvements in both NRS (mean 1.9, 95% confidence interval [CI] 0.4, 3.4; P=0.02) and MBS (mean 2.1, 95% CI 0.6, 3.5; P=0.007). BiPAP also was associated with improvements in NRS (mean 3.2; 95% CI 1.3, 5.1; P=0.004) and MBS (mean 1.5, 95% CI −0.3, 3.2; P=0.13). There were no significant differences between HFO and BiPAP in dyspnea NRS (P=0.14) and MBS (P=0.47). Oxygen saturation improved with HFO (93% vs. 99%, P=0.003), and respiratory rate had a non-statistically significant decrease with both interventions (HFO -3; P=0.11; BiPAP -2, P=0.11 ). No significant adverse effects were observed. Conclusion HFO and BiPAP alleviated dyspnea, improved physiologic parameters and were safe. Our results justify larger randomized controlled trials to confirm these findings.

Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure

“…HUI et al [103] showed a similar improvement in dyspnoea scores between NIV and high-flow oxygen, while a larger multicentre study [104] demonstrated a significantly greater reduction in breathlessness using NIV, especially in the hypercapnic subgroup of patients. Interestingly, the latter investigation showed that NIV might reduce the dose of morphine necessary to palliate dyspnoea, maintaining better cognitive function.…”

Application of palliative ventilation: potential and clinical evidence in palliative care

“…Vital signs, transcutaneous carbon dioxide and adverse effects were also recorded. Both NIVand HFNT were associated with significant and extended relief of dyspnea and enhanced physiologic parameters without significant adverse effects [36].…”

Hypnosis and music interventions (HMIs) inactivate HIF-1: A potential curative efficacy for cancers and hypertension

“…First, the novel molecule myo-inositol trispyrophosphate enhances the oxygenation in the subcellular micro-environment and thus inhibits the growth of colon cancer cells in mice [57]. Second, high-flow oxygen significantly improves the oxygen saturation in cancer patients, alleviating dyspnea and improving the related physiologic parameters [58]. Third, as the main indicator of tissue hypoxia, hemoglobin oxygen saturation significantly correlates with the therapeutic efficacy of chemotherapy for breast cancer, implying that higher oxygen saturation leads to better therapeutic effects [59].…”