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

J Pain Symptom Manage. 2013 Oct;46(4):463-73. doi: 10.1016/j.jpainsymman.2012.10.284. Epub 2013 Jun 2.


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.

Publication types

  • Clinical Trial, Phase II
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Combined Modality Therapy / adverse effects
  • Combined Modality Therapy / methods
  • Continuous Positive Airway Pressure / adverse effects
  • Continuous Positive Airway Pressure / methods*
  • Dyspnea / diagnosis
  • Dyspnea / etiology
  • Dyspnea / rehabilitation*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasms / complications
  • Neoplasms / diagnosis
  • Neoplasms / rehabilitation*
  • Oxygen Inhalation Therapy / adverse effects
  • Oxygen Inhalation Therapy / methods*
  • Palliative Care / methods*
  • Treatment Outcome

Associated data

  • ClinicalTrials.gov/NCT01518140