Noninvasive ventilation supports breathing in patients without the use of a surgical intervention to bypass the upper airway such as an endotracheal tube. Noninvasive ventilation is delivered with a mask or a similar device and has fewer adverse effects than invasive ventilation. Bilevel positive airway pressure (BiPAP) is a type of non-invasive ventilation that is used to treat patients with sleep apnea.
Hui, D., Morgado, M., Chisholm, G., Withers, L., Nguyen, Q., Finch, C., . . . Bruera, E. (2013). High-flow oxygen and bilevel positive airway pressure for persistent dyspnea in patients with advanced cancer: A phase II randomized trial. Journal of Pain and Symptom Management, 46, 463–473.
To examine changes in dyspnea through a randomized trial of high-flow oxygen (HFO) and bilevel positive airway pressure (BiPAP) in patients with cancer
Patients were randomized using a computer-generated randomization scheme in a 1:1 ratio to receive either two hours of HFO followed by a washout period and then two hours of BiPAP or two hours of BiPAP followed by a washout period followed by two hours of HFO. Data on dyspnea were collected every 10 minutes after the first intervention for as much as one hour. Patients participated in the second intervention if their dyspnea level was ≥ baseline dyspnea level minus one or ≥ 3/10 after one hour.
Randomized, open-label study with a parallel design and an optional second intervention
HFO and BiPAP were found to alleviate dyspnea and improve physiologic parameters. The results of this study justify larger randomized, controlled studies to validate these findings. The authors of this study proposed that HFO and BiPAP be examined separately.
Dyspnea is one of the most common symptoms for patients with cancer. This study shows that HFO and BiPAP may alleviate dyspnea. These devices are safe for patients to use. Larger randomized, controlled clinical trials are needed to confirm the findings of this study.
Nava, S., Ferrer, M., Esquinas, A., Scala, R., Groff, P., Cosentini, R., . . . Grassi, M. (2013). Palliative use of non-invasive ventilation in end-of-life patients with solid tumours: A randomised feasibility trial. The Lancet Oncology, 14, 219–227.
To determine the acceptability of solely using palliative noninvasive ventilation (NIV) versus oxygen therapy to manage breathlessness in patients with end-stage cancer and its effects in reducing dyspnea and opioid requirement
Multi-center, randomized, controlled trial
NIV was feasible and effective in decreasing dyspnea intensity and reducing morphine requirements in patients with end-stage cancer experiencing respiratory failure. However, additional studies validating these findings and determining the effects of NIV on survival and quality of life are needed.
This study offers clinicians a treatment modality that can be used in adjunct with opioids to significantly reduce breathlessness in patients with end-stage cancer. Additional studies are needed to determine the specific patient population that would benefit the most from this treatment, its cost effectiveness, patient satisfaction, the adverse effects of NIV, and the survival rate.