Respiratory support strategies and nonconventional ventilation modes in oncologic critical care

Nonconventional modes of ventilation have been around for decades. Starting in the 1970s, several modes of high-frequency ventilation (HFV) were introduced and have been used as experimental or rescue ventilation modes since then. More recently, close-loop dual modes of ventilation have been developed. Biphasic ventilation (BiPAP/APRV) and pressure-regulated volume control (PRVC) are among the most accepted and popular. Other less known include proportional assist ventilation (PAV) and neurally adjusted ventilatory assist (NAVA), among many others. To date, there is little to no evidence available for the use of these modes in cancer patients. We review some of the most important modes in current clinical practice and share our experience in theMD Anderson Cancer Center Intensive Care Units with the use of HFV, BiPAP, and APRVas well our respiratory support strategy to manage cancer patients in respiratory failure.