High-flow oxygen therapy in cancer patients with acute respiratory failure

Abstract

Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-015-3994-8) contains supplementary material, which is available to authorized users.Dear Editor, Acute respiratory failure is a dramatic event and remains a major cause of ICU admission in cancer patients [1]. It has been recently shown that highflow oxygen therapy through a nasal cannula in association with noninvasive ventilation (HFNC-NIV) during acute respiratory failure is associated with high mortality in unselected patients with hypoxemic acute respiratory failure (FLORALI study) [2]. We retrospectively analyzed 178 cancer patients admitted to the ICU for severe acute respiratory failure (O 2 delivery [9 L/min). We computed a propensity score to predict HFNC-NIV treatment based on specific characteristics at ICU admission. The primary outcome was all-causes mortality at day 28; secondary outcomes included the number of ventilator-free days at day 28 and long-term mortality. The study was approved by our institutional review board. For the initial population (n = 178), pulmonary infection (any pathogen) was present in 116 patients (65 %). At ICU admission the median SAPS II was 47 (IQR 38-57), SOFA score 6 (4-9), and PaO 2 /FiO 2 ratio 123 (87-158). A total of 150 patients (84 %) were treated with NIV, 84 (47 %) with HFNC, and 94 (53 %) with standard oxygen. Among these patients, 76 (43 %) were treated with HFNC-NIV, 74 (42 %) with standard O 2 -NIV, 8 (5 %) with standard O 2 alone, and 20 (11 %) with HFNC alone. As compared to the others patients, HFNC-NIV patients presented a lower day-28 mortality rate, 37 % (n = 28) vs 52 % (n = 53), p = 0.045; a longer time from ICU admission to intubation 34 h (18-72) vs 16 h (7-45), p = 0.01; and a higher but not significant number of ventilator-free days, 24 (2-28) vs 8 (1-28), p = 0.06.

Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis

“…58,73,74 The use of high flow oxygen therapy through a nasal cannula (HFNC) associated with NIV recently demonstrated promising results in ARF in cancer patients, with a significant improvement of day-28 mortality and decrease in invasive MV requirement. 75 NIV appears to be highly effective in well-selected situations, such as cardiac edema and capillary leak syndrome, but totally ineffective in lesional pulmonary edema. This strategy deserves to be investigated in allo-HSCT patients.…”

“…In the setting of cancer patients with hypoxemic ARF, HFNC associated with NIV was independently associated with improved survival and lower ventilation-free days. 75 The optimal oxygen delivery system is currently under examination, and a recent publication focused on Venturi mask versus HFNC in ARF immunocompromised patients, with no difference highlighted. 104 …”

Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

“…In another study including patients with cancer and ARF, NHF in combination with NIV was associated with a lower 28-day mortality rate compared to either NHF alone or to a combination of SOT with NIV [71]. These results contrast with the results of the FLORALI (Clinical Effect of the Association of Non-invasive Ventilation and High Flow Nasal Oxygen Therapy in Resuscitation of Patients with Acute Lung Injury) study [26], in which the combination of NHF-NIV in an unselected population with hypoxaemic ARF was associated with high mortality.…”

“…These results contrast with the results of the FLORALI (Clinical Effect of the Association of Non-invasive Ventilation and High Flow Nasal Oxygen Therapy in Resuscitation of Patients with Acute Lung Injury) study [26], in which the combination of NHF-NIV in an unselected population with hypoxaemic ARF was associated with high mortality. It is possible that the differences in the NIV application protocol (time and number of sessions) as well as the different study populations could explain the dissimilar results between studies [26,71]. The beneficial effects of NHF have been highlighted in two further studies in patients with solid tumours [72] and haematologic malignancies [73], where more than one-third of the patients improved while on NHF and another large percentage (44%) remained stable [72], often obviating the need for ICU admission or invasive mechanical ventilation.…”

Focus on immunocompromised patients

“…In critically ill cancer patients at high risk of mortality, there is an urgent need for additional data. In a retrospective cohort study matched and adjusted for potential confounders, Mokart et al found patients receiving both non-invasive ventilation (NIV) and high-flow nasal cannula oxygen therapy (HFNC) to have a lower mortality and more days free from invasive mechanical ventilation at day 28 [9]. This study should be taken cautiously as regard to unmeasured confounders that may have participated in treatment choice, but it does underline the need to perform trials specifically dedicated to this population [7][8][9].…”