Noninvasive mechanical ventilation as a palliative treatment of acute                 respiratory failure in patients with end-stage solid cancer

Cuomo, Annamaria; Delmastro, Monica; Ceriana, Piero; Nava, Stefano; Conti, Giorgio; Antonelli, Massimo; Iacobone, Emanuele

doi:10.1191/0269216304pm933oa

Cited by 122 publications

(55 citation statements)

References 37 publications

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“…14 In one particular study of noninvasive ventilation in oncologic patients, 13 of 23 (57%) patients were successfully supported and discharged alive. 28 In the present study, the mortality rate was 55% for noninvasive mechanical ventilation group; however, when this group was compared with those who did not have noninvasive mechanical ventilation, statistical significance was not reached after adjusting for known confounding factors. The role of early noninvasive mechanical ventilation merits further research.…”

Section: Duringcontrasting

confidence: 59%

Outcomes of stem cell transplant patients with acute respiratory failure requiring mechanical ventilation in the United States

Allareddy

Roy

Rampa

et al. 2014

Bone Marrow Transplant

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SCT indications and procedures are increasing worldwide. We sought to estimate the prevalence of acute respiratory failure (ARF) of any cause in hospitalized SCT patients, and assess the impact of invasive mechanical ventilation (IMV) on outcomes. We hypothesize that duration of IMV in such patients is an independent predictor of higher mortality. We performed a retrospective analysis of the largest all-payer hospitalization data set in the United States, Nationwide In-patient Sample for years [2004][2005][2006][2007][2008][2009][2010]. Of the 101 462 SCT hospitalizations, 6074 (6%) developed ARF and were the final cohort. Type of SCT with ARF included autologous 1987 (32.7%), allogeneic 3467 (57.1%) and cord blood 655 (10.8%). Duration of IMV included o96 h (17.1%) and ⩾ 96 h (41.1%). Overall in-hospital mortality (IHM) was 50.6% (3075). Predictors of IHM were IMV o96 h (odds ratio = 3.42 (2.44-4.79), P o0.0001) or IMV ⩾ 96 h (OR = 4.61 (3.17-6.70), P o 0.0001). Type of SCT, comorbid burden, gender, hospital-teaching status/bed size or insurance did not influence IHM. IMV ⩾ 96 h was associated with higher hospital charges (mean $762 515, 95% estimate 0.3991 (0.3123-0.4859), increase of $304 474, P o 0.0001) and higher length of stay (mean 61.5 days, 95% estimate 0.2198 (0.1531-0.2866), increase of 13 days, P o 0.0001). In conclusion, ARF in hospitalized SCT patients is not an uncommon occurrence and is associated with 50% mortality. Duration of IMV (⩾96 h) was an independent predictor of higher mortality rates. Hospital resource utilization was significant.

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Section: Duringcontrasting

confidence: 59%

Outcomes of stem cell transplant patients with acute respiratory failure requiring mechanical ventilation in the United States

Allareddy

Roy

Rampa

et al. 2014

Bone Marrow Transplant

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“…Concerning the use of NIV as a "sole" palliative measure to relieve dyspnea, 60 a recent RCT 61 found that in end-stage solid cancer patients, NIV improved dyspnea faster than did oxygen alone, and reduced the amount of morphine needed.…”

Section: Niv In Patients With Do-not-intubate Orders and For Symptom mentioning

confidence: 99%

Behind a Mask: Tricks, Pitfalls, and Prejudices for Noninvasive Ventilation

Nava

2013

Respir Care

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It is difficult to exactly date the beginning of mechanical ventilation, but there are no doubts that noninvasive ventilation (NIV) was the first method of ventilatory support in clinical practice. The technique had a sudden increase in popularity, so that it is now considered, according to criteria of evidence-based medicine, the first-line treatment for an episode of acute respiratory failure in 4 pathologies (the Fabulous Four): COPD exacerbation, cardiogenic pulmonary edema, pulmonary infiltrates in immunocompromised patients, and in the weaning of extubated COPD patients. The so-called emerging applications are those for which the evidence has not achieved level A, mainly because the number or sample size of the published studies does not allow conclusive meta-analysis. These emerging applications are the post-surgical period, palliation of dyspnea, asthma attack, obesity hypoventilation syndrome, and to prevent extubation failure. Potentially "risky business" uses include for respiratory failure from pandemic diseases and ARDS, where probably the "secret" for success is early use. Healthcare is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly, if at all, so their clinical use remains limited and heterogeneous. The low rate of NIV use in some hospitals relates to lack of knowledge about or experience with NIV, insufficient confidence in the technique, lack of NIV equipment, and inadequate funding. But NIV use has been increasing around the world, thanks partly to improved technologies. The skill and confidence of clinicians in NIV have improved with time and experience, but NIV is and should remain a team effort, rather than the property of a single local "champion," because, overall, NIV is beautiful!

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“…NPPV reduces dyspnoea even in the absence of hypercapnic respiratory failure [110]. The Society of Critical Care Medicine has recently charged a task force with the development of an approach for considering use of NPPV in patients who choose to forgo endotracheal intubation.…”

Section: Nppv In Palliative Carementioning

confidence: 99%

Nonpharmacological treatment and relief of symptoms in COPD

Clini

Ambrosino²

2008

European Respiratory Journal

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Evidence-based guidelines for chronic obstructive pulmonary disease (COPD) have recently been developed.Nonpharmacological treatments have evolved rapidly as an essential part of COPD therapy. They are especially important as complementary interventions in severe or very severe disease, when there is loss in function, a reduction in quality of life and when psychological impairments further complicate the disease.The present article discusses the most used nonpharmacological treatments for severe COPD patients (rehabilitation, long-term oxygen therapy, surgery, noninvasive positive pressure ventilation and supportive nutrition) and their evidence-based usefulness in promoting strategies that relieve symptoms.All of these interventions are used during end-stage disease, to promote self-efficacy, relieve symptoms and prevent further deterioration. These therapeutic options support physicians and allied professionals in improving symptom management for their patients.

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Noninvasive mechanical ventilation as a palliative treatment of acute respiratory failure in patients with end-stage solid cancer

Cited by 122 publications

References 37 publications

Outcomes of stem cell transplant patients with acute respiratory failure requiring mechanical ventilation in the United States

Outcomes of stem cell transplant patients with acute respiratory failure requiring mechanical ventilation in the United States

Behind a Mask: Tricks, Pitfalls, and Prejudices for Noninvasive Ventilation

Nonpharmacological treatment and relief of symptoms in COPD

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