A210 Feasibility of Non-Invasive Mechanical Ventilation in the Treatment of Acute Respiratory Failure in Cancer Patients

Abstract Background: Acute hypoxemic respiratory failure is one of the leading causes of intensive care unit admission and associated with high mortality. Non-invasive oxygenation strategies such as high flow nasal cannula, standard oxygen therapy and non-invasive ventilation (delivered by either face mask or helmet interface) are widely available interventions applied in these patients. It remains unclear which of these interventions are more effective in decreasing rates of invasive mechanical ventilation and mortality. The primary objective of this network meta-analysis is to summarize the evidence and compare the effect of non-invasive oxygenation strategies on mortality and need for invasive mechanical ventilation in patients with acute hypoxemic respiratory failure. Methods: We will search key databases for randomized controlled trials assessing the effect of non-invasive oxygenation strategies in adult patients with acute hypoxemic respiratory failure. We will exclude studies in which the primary focus is either acute exacerbations of chronic obstructive pulmonary disease or cardiogenic pulmonary edema. The primary outcome will be all-cause mortality (longest available up to 90 days). The secondary outcomes will be receipt of invasive mechanical ventilation (longest available up to 30 days). We will assess the risk of bias for each of the outcomes using the Cochrane Risk of Bias Tool. Bayesian network meta-analyses will be conducted to obtain pooled estimates of head-to-head comparisons. We will report pairwise and network meta-analysis treatment effect estimates as risk ratios and 95% credible intervals. Subgroup analyses will be conducted examining key populations including immunocompromised hosts. Sensitivity analyses will be conducted by excluding those studies with high risk of bias and different etiologies of acute respiratory failure. We will assess certainty in effect estimates using GRADE methodology. Discussion : This study will help to guide clinical decision making when caring for adult patients with AHRF and improve our understanding of the limitations of the available literature assessing noninvasive oxygenation strategies in acute hypoxemic respiratory failure.

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Role of Non-Invasive Mechanical Ventilation for Acute Respiratory Failure in Cancer Patients

Nepalese Medical Journal ◽

10.3126/nmj.v3i1.28289 ◽

2020 ◽

Vol 3 (1) ◽

pp. 298-301

Author(s):

Madindra Bahadur Basnet ◽

Krishna Prasad Acharya ◽

Deepak Adhikari

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Cancer Patients ◽

Invasive Mechanical Ventilation ◽

Invasive Ventilation ◽

Timely Initiation ◽

Non Invasive ◽

Non Invasive Ventilation

Introduction: Acute respiratory failure is a common cause of Intensive care Unit admission for cancer patients. Non-invasive ventilation comes in between the two extreme situations: either provide only oxygen or ventilate invasively. This study was done to find the usefulness and efficacy of non-invasive ventilation in a cancer patient. Materials and Methods: A cross-sectional study was done at Nepal Cancer Hospital. Data analysis of patients requiring non-invasive ventilation at the Intensive care Unit from April 14, 2018, to April 13, 2019, were included. Results: Among 68 studied patients, the primary reason for the initiation of non-invasive ventilation sepsis (16.32%), pneumonia (10.88%), and lung cancer (10.2%). Postoperative atelectasis, pulmonary edema, and morphine overdose were associated with good respiratory improvement and Intensive care Unit survival (100%, 75% and 66.67% respectively). Respiratory failure with carcinoma lung, lung fibrosis, acute respiratory distress syndrome, terminally ill patients, and patients with low Glasgow Coma Scale had high failure rates (Survival: 13.33%, 14.29%, 16.67%, 0%, and 20% respectively). Conclusions: Non-invasive ventilation seems to be an effective way of ventilation for cancer patients. The selection of patients and timely initiation of non-invasive ventilation is of utmost importance for a better outcome.

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