High-flow oxygen and bilevel positive airway pressure for persistent dyspnea in patients with advanced cancer: a phase II randomized trial

Abstract

Context: 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.

Objectives: 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.

Conclusion: HFO and BiPAP alleviated dyspnea, improved physiologic parameters, and were safe. Our results justify larger randomized controlled trials to confirm these findings.

Keywords: Dyspnea; bilevel positive airway pressure; high flow oxygen; neoplasms; oxygen; positive-pressure respiration; randomized controlled trial.

Conflict of interest statement

Disclosures

The authors declare no conflicts of interest

Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Figures

Fig. 1. Study flow chart

Fig. 2. Change in dyspnea scores with high flow oxygen and BiPAP

As compared with baseline, BiPAP was associated with an average improvement in (A) the dyspnea numeric rating scale of 3.2 (P=0.004) and (B) the modified Borg scale of 1.5 (P=0.13). High flow oxygen was also associated with an average improvement in (C) the numeric rating scale of 1.9 (P=0.02) and (D) the modified Borg scale of 2.1 (P=0.007). Intention-to-treat analysis revealed no significant differences between the two devices with the dyspnea numeric rating scale (P=0.32) and the modified Borg scale (P=0.29).

Fig. 3. Global Symptom Evaluation for high flow oxygen and BiPAP

Patients were asked to provide their overall impression about the change in dyspnea level (“worse,” “about the same,” or “better”) using the Global Symptom Evaluation scale. Consistent with the dyspnea scores, a majority of patients reported that high flow oxygen and BiPAP were efficacious in relieving their dyspnea.