High-Flow Oxygen and Bilevel Positive Airway Pressure for Persistent Dyspnea in Patients With Advanced Cancer: A Phase II Randomized Trial
High-Flow Oxygen and Bilevel Positive Airway Pressure for Persistent Dyspnea in Patients With Advanced Cancer: A Phase II Randomized Trial
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DOI：
10.1016/j.jpainsymman.2012.10.284
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发表时间：
2013-10-01
影响因子：
4.7
通讯作者：
Bruera, Eduardo
中科院分区：
文献类型：
--
作者：
Hui, David;Morgado, Margarita;Bruera, Eduardo
上下文呼吸困难是癌症患者最痛苦的症状之一。高流量吸氧（HFO）和双水平气道正压通气（BiPAP）在缓解呼吸困难中的作用尚未得到很好的表征。目的：探讨HFO和BiPAP在癌症患者中随机应用的可行性，并观察两种治疗方式对患者呼吸困难、生理参数和不良反应的影响。在这项随机研究中（临床试验。gov标识符：NCT 01518140），我们将患有晚期癌症和持续呼吸困难的住院患者分配到HFO或BiPAP治疗2小时。我们在干预前后用数字评定量表（NRS）和改良的博格量表（MBS）评估呼吸困难。我们还记录了生命体征、经皮二氧化碳和不良反应。入组了30例患者（比例1：1），23例（77%）完成了分配的干预。HFO与NRS（平均值1.9; 95% CI 0.4-3.4; P=0.02）和MBS（平均值2.1; 95% CI 0.6-3.5; P=0.007）的改善相关。BiPAP还与NRS（平均值3.2; 95% CI 1.3-5.1; P=0.004）和MBS（平均值1.5; 95% CI-0.3，3.2; P=0.13）的改善相关。HFO和BiPAP在呼吸困难NRS（P=0.14）和MBS（P=0.47）方面无显著差异。HFO改善了氧饱和度（93% vs. 99%; P=0.003），两种干预措施的呼吸频率均无统计学显著性降低（HFO-3，P=0.11; BiPAP-2，P=0.11）。无明显不良反应。HFO和BiPAP缓解了呼吸困难，改善了生理参数，并且安全。我们的结果证明了更大的随机对照试验来证实这些发现。(C)2013年美国癌症疼痛缓解委员会。爱思唯尔公司出版All rights reserved.
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. (C) 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.