Palliative use of non-invasive ventilation in end-of-life patients with solid tumours: a randomised feasibility trial

摘要: Summary Background Despite best-possible medical management, many patients with end-stage cancer experience breathlessness, especially towards the end of their lives. We assessed acceptability and effectiveness non-invasive mechanical ventilation (NIV) versus oxygen therapy in decreasing dyspnoea amount opiates needed. Methods In this randomised feasibility study, we recruited from seven centres Italy, Spain, Taiwan, who had solid tumours acute respiratory failure a life expectancy less than 6 months. randomly allocated to receive either NIV (using Pressure Support mode scheduled on patients' request mask comfort) or Venturi reservoir mask). used computer-generated sequence for randomisation, stratified basis hypercapnic status (PaCO 2 >45 mm Hg PaCO ≤45 Hg), assigned treatment allocation using opaque, sealed envelopes. Patients both groups were given sufficient subcutaneous morphine reduce score by at least one point Borg scale. Our primary endpoints assess solely as palliative measure its reducing needed compared therapy. Analysis was done intention treat. This study is registered ClinicalTrials.gov, number NCT00533143. Findings between Jan 15, 2008, March 9, 2011. Of 234 eligible recruitment, 200 (85%) treatment: 99 101 oxygen. 11 (11%) group discontinued treatment; no treatment. Dyspnoea decreased more rapidly (average change scale −0·58, 95% CI −0·92 −0·23, p=0·0012), most benefit seen after first hour patients. The total dose during 48 h lower it (26·9 mg [37·3] vs 59·4 [SD 67·1] oxygen; mean difference −32·4 mg, −47·5 −17·4). Adverse events leading discontinuation mainly related intolerance anxiety. Morphine suspended because severe vomiting nausea (one patient each group), sudden arrest myocardial infarction group). Interpretation findings suggest that effective doses cancer. Further studies are confirm our other outcomes such survival. use is, however, restricted equipment, not generalisable all care units. Funding None.