High-Flow Oxygen and Bilevel Positive Airway Pressure for Persistent Dyspnea in Patients With Advanced Cancer: A Phase II Randomized Trial

Abstract

ContextDyspnea 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. ObjectivesTo 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. MethodsIn 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. ResultsThirty 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. ConclusionHFO and BiPAP alleviated dyspnea, improved physiologic parameters, and were safe. Our results justify larger randomized controlled trials to confirm these findings.