TY - JOUR
T1 - High-Flow Oxygen and High-Flow Air for Dyspnea in Hospitalized Patients with Cancer
T2 - A Pilot Crossover Randomized Clinical Trial
AU - Hui, David
AU - Hernandez, Farley
AU - Urbauer, Diana
AU - Thomas, Saji
AU - Lu, Zhanni
AU - Elsayem, Ahmed
AU - Bruera, Eduardo
N1 - Publisher Copyright:
© 2020 AlphaMed Press
PY - 2021/5
Y1 - 2021/5
N2 - Background: The effect of high-flow oxygen (HFOx) and high-flow air (HFAir) on dyspnea in nonhypoxemic patients is not known. We assessed the effect of HFOx, HFAir, low-flow oxygen (LFOx), and low-flow air (LFAir) on dyspnea. Subjects, Materials, and Methods: This double-blind, 4×4 crossover clinical trial enrolled hospitalized patients with cancer who were dyspneic at rest and nonhypoxemic (oxygen saturation >90% on room air). Patients were randomized to 10 minutes of HFOx, HFAir, LFOx, and LFAir in different orders. The flow rate was titrated between 20–60 L/minute in the high-flow interventions and 2 L/minute in the low-flow interventions. The primary outcome was dyspnea numeric rating scale (NRS) “now” where 0 = none and 10 = worst. Results: Seventeen patients (mean age 51 years, 58% female) completed 55 interventions in a random order. The absolute change of dyspnea NRS between 0 and 10 minutes was −1.8 (SD 1.7) for HFOx, −1.8 (2.0) for HFAir, −0.5 (0.8) for LFOx, and − 0.6 (1.2) for LFAir. In mixed model analysis, HFOx provided greater dyspnea relief than LFOx (mean difference [95% confidence interval] −0.80 [−1.45, −0.15]; p =.02) and LFAir (−1.24 [−1.90, −0.57]; p <.001). HFAir also provided significantly greater dyspnea relief than LFOx (−0.95 [−1.61, −0.30]; p =.005) and LFAir (−1.39 [−2.05, −0.73]; p <.001). HFOx was well tolerated. Seven (54%) patients who tried all interventions blindly preferred HFOx and four (31%) preferred HFAir. Conclusion: We found that HFOx and HFAir provided a rapid and clinically significant reduction of dyspnea at rest in hospitalized nonhypoxemic patients with cancer. Larger studies are needed to confirm these findings (Clinicaltrials.gov: NCT02932332). Implications for Practice: This double-blind, 4×4 crossover trial examined the effect of oxygen or air delivered at high- or low-flow rates on dyspnea in hospitalized nonhypoxemic patients with cancer. High-flow oxygen and high-flow air were significantly better at reducing dyspnea than low-flow oxygen/air, supporting a role for palliation beyond oxygenation.
AB - Background: The effect of high-flow oxygen (HFOx) and high-flow air (HFAir) on dyspnea in nonhypoxemic patients is not known. We assessed the effect of HFOx, HFAir, low-flow oxygen (LFOx), and low-flow air (LFAir) on dyspnea. Subjects, Materials, and Methods: This double-blind, 4×4 crossover clinical trial enrolled hospitalized patients with cancer who were dyspneic at rest and nonhypoxemic (oxygen saturation >90% on room air). Patients were randomized to 10 minutes of HFOx, HFAir, LFOx, and LFAir in different orders. The flow rate was titrated between 20–60 L/minute in the high-flow interventions and 2 L/minute in the low-flow interventions. The primary outcome was dyspnea numeric rating scale (NRS) “now” where 0 = none and 10 = worst. Results: Seventeen patients (mean age 51 years, 58% female) completed 55 interventions in a random order. The absolute change of dyspnea NRS between 0 and 10 minutes was −1.8 (SD 1.7) for HFOx, −1.8 (2.0) for HFAir, −0.5 (0.8) for LFOx, and − 0.6 (1.2) for LFAir. In mixed model analysis, HFOx provided greater dyspnea relief than LFOx (mean difference [95% confidence interval] −0.80 [−1.45, −0.15]; p =.02) and LFAir (−1.24 [−1.90, −0.57]; p <.001). HFAir also provided significantly greater dyspnea relief than LFOx (−0.95 [−1.61, −0.30]; p =.005) and LFAir (−1.39 [−2.05, −0.73]; p <.001). HFOx was well tolerated. Seven (54%) patients who tried all interventions blindly preferred HFOx and four (31%) preferred HFAir. Conclusion: We found that HFOx and HFAir provided a rapid and clinically significant reduction of dyspnea at rest in hospitalized nonhypoxemic patients with cancer. Larger studies are needed to confirm these findings (Clinicaltrials.gov: NCT02932332). Implications for Practice: This double-blind, 4×4 crossover trial examined the effect of oxygen or air delivered at high- or low-flow rates on dyspnea in hospitalized nonhypoxemic patients with cancer. High-flow oxygen and high-flow air were significantly better at reducing dyspnea than low-flow oxygen/air, supporting a role for palliation beyond oxygenation.
KW - Clinical trial
KW - Hospital equipment
KW - Neoplasms
KW - Oxygen
KW - dyspnea
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U2 - 10.1002/onco.13622
DO - 10.1002/onco.13622
M3 - Article
C2 - 33289276
AN - SCOPUS:85097542976
SN - 1083-7159
VL - 26
SP - e883-e892
JO - Oncologist
JF - Oncologist
IS - 5
ER -