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TORONTO — Noninvasive mechanical ventilation alleviated respiratory distress in end-stage cancer patients in a randomized study that compared this palliative modality with the administration of oxygen, Dr. Stefano Nava reported at an international conference of the American Thoracic Society.
“In end-stage cancer we concentrate on relieving bodily pain with morphine, but we overlook the pain of the respiratory system, which is dyspnea,” said Dr. Nava, chief of the respiratory critical care unit at Instituto Scientifico di Pavia (Italy).
Oxygen is routinely administered along with morphine in this situation, but there has never been a randomized trial evaluating any technique for easing respiratory distress in these patients and there is no evidence that oxygen is actually beneficial, he said.
To address this uncertainty, the trial was undertaken in six European centers, comparing noninvasive mechanical ventilation (NIV) using a face mask to oxygen administered via nasal cannula. NIV involves the use of positive pressure to aid in breathing, as does conventional mechanical ventilation, but does not require intubation, Dr. Nava explained.
For enrollment in the study, patients had to have acute respiratory failure and distress, with a Borg dyspnea score greater than 3 and a respiratory rate exceeding 25 breaths per minute.
A total of 126 patients were randomized. All of them had solid cancers, and mortality was 80%, as expected, Dr. Nava said. Clearly, survival was not increased. “In fact, we explain to patients that NIV may unduly prolong life, even if only for a few hours,” he said.
Overall, there was a similar degree of relief in both groups, but the effects were more rapid with NIV. Borg dyspnea score in the NIV group fell significantly from 6.9 on admission to 5.7 at 1 hour, to 4.7 at 3 hours, and to 3.9 at 24 hours. By comparison, a significant decrease from 6.7 on admission to 5.5 was seen only at 3 hours and to 4.8 at 24 hours in the oxygen group.
Morphine use also was lower in the NIV group in the first 24 hours, at 12.2 mg/day, compared with 19.6 mg/day in the oxygen group. “This is important for patients, as it allows the sensorium to remain clearer and they are able to say goodbye and sign papers if necessary, which are not trivial things,” Dr. Nava commented in a press briefing.
With NIV, the mask is worn only intermittently, so the patient also can drink and eat if able. In Europe, NIV is now used for up to 40%–50% of ventilated patients in the intensive care unit, but it has not yet been widely adopted in North America, he said.
TORONTO — Noninvasive mechanical ventilation alleviated respiratory distress in end-stage cancer patients in a randomized study that compared this palliative modality with the administration of oxygen, Dr. Stefano Nava reported at an international conference of the American Thoracic Society.
“In end-stage cancer we concentrate on relieving bodily pain with morphine, but we overlook the pain of the respiratory system, which is dyspnea,” said Dr. Nava, chief of the respiratory critical care unit at Instituto Scientifico di Pavia (Italy).
Oxygen is routinely administered along with morphine in this situation, but there has never been a randomized trial evaluating any technique for easing respiratory distress in these patients and there is no evidence that oxygen is actually beneficial, he said.
To address this uncertainty, the trial was undertaken in six European centers, comparing noninvasive mechanical ventilation (NIV) using a face mask to oxygen administered via nasal cannula. NIV involves the use of positive pressure to aid in breathing, as does conventional mechanical ventilation, but does not require intubation, Dr. Nava explained.
For enrollment in the study, patients had to have acute respiratory failure and distress, with a Borg dyspnea score greater than 3 and a respiratory rate exceeding 25 breaths per minute.
A total of 126 patients were randomized. All of them had solid cancers, and mortality was 80%, as expected, Dr. Nava said. Clearly, survival was not increased. “In fact, we explain to patients that NIV may unduly prolong life, even if only for a few hours,” he said.
Overall, there was a similar degree of relief in both groups, but the effects were more rapid with NIV. Borg dyspnea score in the NIV group fell significantly from 6.9 on admission to 5.7 at 1 hour, to 4.7 at 3 hours, and to 3.9 at 24 hours. By comparison, a significant decrease from 6.7 on admission to 5.5 was seen only at 3 hours and to 4.8 at 24 hours in the oxygen group.
Morphine use also was lower in the NIV group in the first 24 hours, at 12.2 mg/day, compared with 19.6 mg/day in the oxygen group. “This is important for patients, as it allows the sensorium to remain clearer and they are able to say goodbye and sign papers if necessary, which are not trivial things,” Dr. Nava commented in a press briefing.
With NIV, the mask is worn only intermittently, so the patient also can drink and eat if able. In Europe, NIV is now used for up to 40%–50% of ventilated patients in the intensive care unit, but it has not yet been widely adopted in North America, he said.
TORONTO — Noninvasive mechanical ventilation alleviated respiratory distress in end-stage cancer patients in a randomized study that compared this palliative modality with the administration of oxygen, Dr. Stefano Nava reported at an international conference of the American Thoracic Society.
“In end-stage cancer we concentrate on relieving bodily pain with morphine, but we overlook the pain of the respiratory system, which is dyspnea,” said Dr. Nava, chief of the respiratory critical care unit at Instituto Scientifico di Pavia (Italy).
Oxygen is routinely administered along with morphine in this situation, but there has never been a randomized trial evaluating any technique for easing respiratory distress in these patients and there is no evidence that oxygen is actually beneficial, he said.
To address this uncertainty, the trial was undertaken in six European centers, comparing noninvasive mechanical ventilation (NIV) using a face mask to oxygen administered via nasal cannula. NIV involves the use of positive pressure to aid in breathing, as does conventional mechanical ventilation, but does not require intubation, Dr. Nava explained.
For enrollment in the study, patients had to have acute respiratory failure and distress, with a Borg dyspnea score greater than 3 and a respiratory rate exceeding 25 breaths per minute.
A total of 126 patients were randomized. All of them had solid cancers, and mortality was 80%, as expected, Dr. Nava said. Clearly, survival was not increased. “In fact, we explain to patients that NIV may unduly prolong life, even if only for a few hours,” he said.
Overall, there was a similar degree of relief in both groups, but the effects were more rapid with NIV. Borg dyspnea score in the NIV group fell significantly from 6.9 on admission to 5.7 at 1 hour, to 4.7 at 3 hours, and to 3.9 at 24 hours. By comparison, a significant decrease from 6.7 on admission to 5.5 was seen only at 3 hours and to 4.8 at 24 hours in the oxygen group.
Morphine use also was lower in the NIV group in the first 24 hours, at 12.2 mg/day, compared with 19.6 mg/day in the oxygen group. “This is important for patients, as it allows the sensorium to remain clearer and they are able to say goodbye and sign papers if necessary, which are not trivial things,” Dr. Nava commented in a press briefing.
With NIV, the mask is worn only intermittently, so the patient also can drink and eat if able. In Europe, NIV is now used for up to 40%–50% of ventilated patients in the intensive care unit, but it has not yet been widely adopted in North America, he said.