TY - JOUR
T1 - High-flow oxygen and bilevel positive airway pressure for persistent dyspnea in patients with advanced cancer
T2 - A phase II randomized trial
AU - Hui, David
AU - Morgado, Margarita
AU - Chisholm, Gary
AU - Withers, Laura
AU - Nguyen, Quan
AU - Finch, Clarence
AU - Frisbee-Hume, Susan
AU - Bruera, Eduardo
N1 - Funding Information:
Dr. Bruera is supported in part by National Institutes of Health grants RO1NR010162-01A1 , RO1CA122292-01 , and RO1CA124481-01 . Dr. Hui is supported in part by an institutional startup grant ( #18075582 ). This study also was supported by the M.D. Anderson Cancer Center Support Grant ( CA 016672 ). The funding sources were not involved in the conduct of the study or development of the submission. The authors declare no conflicts of interest.
PY - 2013/10
Y1 - 2013/10
N2 - 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 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% 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 nonstatistically 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.
AB - 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 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% 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 nonstatistically 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.
KW - Dyspnea
KW - bilevel positive airway pressure
KW - high flow oxygen
KW - neoplasms
KW - oxygen
KW - positive-pressure respiration
KW - randomized controlled trial
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U2 - 10.1016/j.jpainsymman.2012.10.284
DO - 10.1016/j.jpainsymman.2012.10.284
M3 - Article
C2 - 23739633
AN - SCOPUS:84885293950
SN - 0885-3924
VL - 46
SP - 463
EP - 473
JO - Journal of pain and symptom management
JF - Journal of pain and symptom management
IS - 4
ER -