Acute respiratory failure in the cancer patient: the role of non-invasive mechanical ventilation

Nava, Stefano; Cuomo, Anna Maria

doi:10.1016/j.critrevonc.2004.04.004

Cited by 39 publications

(17 citation statements)

References 80 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our results are consistent with the only other study examining dyspnea in cancer patients, in which the MBS decreased from 5.5 to 2.3 after one hour of BiPAP (15). BiPAP not only assists ventilation but also corrects hypoventilation, increases the inspiratory flow rate, resets the central respiratory drive, and reduces the work of respiratory muscles (10, 31). This last mechanism is of particular interest for patients with advanced cancer who have dyspnea secondary to respiratory muscle weakness.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to high flow oxygenation, it also provides nasopharyngeal washout and positive distending pressure, and decreases airway resistance and the metabolic cost of breathing, all of which may alleviate dyspnea (9). BiPAP not only delivers supplemental oxygen but also assists ventilation and unloads respiratory muscles (10). These interventions may further stimulate the trigeminal nerve, similar to the mechanism of the fan (11).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Hui

Morgado

Chisholm

et al. 2013

Journal of Pain and Symptom Management

107

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Hui

Morgado

Chisholm

et al. 2013

Journal of Pain and Symptom Management

107

View full text Add to dashboard Cite

show abstract

“…In dieser Situation besteht die Option, eine Intubation durch NIV zu verhindern [22]. In ei− ner aktuellen Pilotstudie wurde gezeigt, dass NIV als Palliativ− maßnahme bei Krebspatienten in der Terminalphase durchaus sinnvoll eingesetzt werden kann [23,24]. Die retrospektive Un− tersuchung von zwei Patientenkollektiven mit hämatologischen Erkrankungen und akuter Atmungsinsuffizienz, die im Zeitraum von 1990 ± 1995 ohne NIV und von 1996 ± 1998 mit NIV auf der Intensivstation behandelt wurden, ergab, dass die Überlebensra− te mit NIV deutlich zunahm [25].…”

Section: Nicht Invasive Beatmung (Niv) Als Palliative Interventionunclassified

Ethische Betrachtungen zur Beatmungsmedizin unter besonderer Berücksichtigung des Lebensendes

Schönhofer

Köhler²,

Kutzer³

2006

Pneumologie

View full text Add to dashboard Cite

Invasiveness of interventions, complexity of diseases and patients' age are increasing in intensive care medicine. Ethical and legal issues are particularly challenging at the end of life of critically ill patients. At the borderline between intensive care and palliative medicine a significant amount of patients suffer from respiratory failure. Modern modes of mechanical ventilation may be able to improve ventilation and quality of life. On the other hand they may oppose a dignified death at the end of a long lasting chronic disease and e. g. prolong the suffering. In contrast to endotracheal intubation and invasive mechanical ventilation NIV enables patients to participate in the decision making process. While under normal circumstances, ethical standards dictate that patients themselves participate in the medical decision making process. For several reasons this is not always possible in intensive care medicine. However, chronically ill patients should get information from experts already at an early stage of the disease, go through a shared decision process and declare their will concerning interventions of intensive care medicine, e. g. mechanical ventilation. With respect to ethical and legal aspects of end of life this paper deals with chances of mechanical ventilation, including its withdrawal and withholding.

show abstract

“…We do know that early ICU admission, early use of NIV in critically ill lung cancer patients with acute respiratory failure, is associated with better outcomes and also avoids the need for ETI. 1,3 Second, the authors do report that prolonged IMV has deleterious association with mortality. However, they had failed to provide information on IMV discontinuation as part of end-of-life care and palliative care for critically ill lung cancer patients with MOF and advanced disease state.…”

mentioning

confidence: 99%

Lung cancer and intensive care admission: Is this a matter for ICU practice and policy?

Esquinas

Pravinkumar

2014

Asia-Pac J Clin Oncol

View full text Add to dashboard Cite

Acute respiratory failure in the cancer patient: the role of non-invasive mechanical ventilation

Cited by 39 publications

References 80 publications

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

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

Ethische Betrachtungen zur Beatmungsmedizin unter besonderer Berücksichtigung des Lebensendes

Lung cancer and intensive care admission: Is this a matter for ICU practice and policy?

Contact Info

Product

Resources

About