Feasibility of noninvasive mechanical ventilation in the treatment of acute respiratory failure in postoperative cancer patients

Abstract

Patients with cancer who require mechanical ventilation have high mortality rates. Although oncological patients have multiple clinical problems, including nutritional and immunological deficiencies, added complications from mechanical ventilation by themselves may be life-threatening and may further compromise the ability of these patients to recover from an episode of acute respiratory failure (ARF). Noninvasive mechanical ventilatory support (NIMV) using positive-pressure-ventilation delivered through a mask has gained popularity for the treatment of ARF and may limit some mechanical ventilation complications. The purpose of this study was to prospectively evaluate NIMV in cancer patients with ARF. All patients admitted to the surgical intensive care unit (SICU) at The University of Texas M.D. Anderson Cancer Center from August 1, 1994, to April 15, 1996, with hypoxemic or hypercapnic ARF were eligible for this study. NIMV was delivered with the BiPAP S/T-D (Respironics, Murrysville, PA) device. The initial settings were adjusted to achieve a tidal volume of 5 to 7 mL/kg and a SaO2 greater than 0.90. Demographic data, duration of therapy, and need for endotracheal intubation were recorded for each patient. Sixty patients were included in this study. There were 21 women (35%) and 39 men. The primary cancer sites of these patients were gastrointestinal (25 patients), genitourinary (15), hematological (8), lung (6), sarcoma (4), and skin (2). Fifty-three patients (88%) had hypoxemic ARF and 7 had hypercapnic ARF. The mean duration of NIMV was 1.83 days (range, 1 to 5 days) with a median of 2 days. Forty-two patients (70%) were weaned from NIMV and were spared endotracheal intubation. The remaining 18 patients deteriorated and ultimately required intubation and assisted mechanical ventilation. No complications related to the use of NIMV were seen in this study population. NIMV was effective in the treatment of ARF in cancer patients at our institution substantially decreasing the need for intubation. This ventilatory technique is a viable option for cancer patients with ARF.