title: High-flow oxygen and bilevel positive airway pressure for persistent dyspnea in patients with advanced cancer: a phase II randomized trial.
abstract: BACKGROUND
  Dyspnea 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.
  
  
  OBJECTIVE
  To 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.
  
  
  METHODS
  In 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.
  
  
  RESULTS
  Thirty 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.
  
  
  CONCLUSIONS
  HFO and BiPAP alleviated dyspnea, improved physiologic parameters, and were safe. Our results justify larger randomized controlled trials to confirm these findings.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, M.D. Anderson Cancer Center, Houston, Texas, USA. Electronic address: dhui@mdanderson.org.
authors.forename: David
authors.initials: D
authors.lastname: Hui
authors.forename: Margarita
authors.initials: M
authors.lastname: Morgado
authors.forename: Gary
authors.initials: G
authors.lastname: Chisholm
authors.forename: Laura
authors.initials: L
authors.lastname: Withers
authors.forename: Quan
authors.initials: Q
authors.lastname: Nguyen
authors.forename: Clarence
authors.initials: C
authors.lastname: Finch
authors.forename: Susan
authors.initials: S
authors.lastname: Frisbee-Hume
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects / Q000379:methods*; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis / Q000534:rehabilitation*; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects / Q000379:methods*; D010166:Palliative Care / Q000379:methods*; D016896:Treatment Outcome
keywords: Dyspnea; bilevel positive airway pressure; high flow oxygen; neoplasms; oxygen; positive-pressure respiration; randomized controlled trial