BACKGROUND: Respiratory signs and symptoms are commonly encountered by physicians who care for cancer patients. Supplemental oxygen (SOx) has long been used for treatment of hypoxic respiratory insufficiency, but data reveal mixed efficacy results. The use and outcome patterns of technologically advanced oxygen delivery devices, such as humidified high-flow nasal oxygen (HHFNOx), are incompletely understood. METHODS: Institutional database search of the number of patient cases in which the current HHFNOx device was used, and abstraction of 183 patient medical records for usage characteristics. RESULTS: Patients have been treated with HHFNOx at Memorial Sloan Kettering Cancer Center (MSKCC) since 2008. Of the 183 patients randomly selected for our study, 72% received HHFNOx in the intensive care unit (ICU) because of hypoxia. Patients usually improved (41%) or remained stable (44%) while on the device, whereas 15% declined. At study completion, 45% of patients were living, and 55% had died. The median time on HHFNOx was 3 days (range: 1-27). A do not resuscitate (DNR) order was present in 101 (55%) patients, either before (12%) or after (43%) device utilization. The majority (78%) of these 101 patients died at MSKCC. CONCLUSION: Dyspnea is a common and important symptom in cancer patients for which SOx traditionally has had no clear basis except in select cases of hypoxia and patient preference. Our institutional experience with HHFNOx contributes to the understanding of the applications and challenges surrounding the use of new medical devices in the cancer population. Physiologic and quality-of-life benefits of HHFNOx compared with traditional oxygen delivery methods should be studied prospectively.
BACKGROUND: Respiratory signs and symptoms are commonly encountered by physicians who care for cancerpatients. Supplemental oxygen (SOx) has long been used for treatment of hypoxic respiratory insufficiency, but data reveal mixed efficacy results. The use and outcome patterns of technologically advanced oxygen delivery devices, such as humidified high-flow nasal oxygen (HHFNOx), are incompletely understood. METHODS: Institutional database search of the number of patient cases in which the current HHFNOx device was used, and abstraction of 183 patient medical records for usage characteristics. RESULTS:Patients have been treated with HHFNOx at Memorial Sloan Kettering Cancer Center (MSKCC) since 2008. Of the 183 patients randomly selected for our study, 72% received HHFNOx in the intensive care unit (ICU) because of hypoxia. Patients usually improved (41%) or remained stable (44%) while on the device, whereas 15% declined. At study completion, 45% of patients were living, and 55% had died. The median time on HHFNOx was 3 days (range: 1-27). A do not resuscitate (DNR) order was present in 101 (55%) patients, either before (12%) or after (43%) device utilization. The majority (78%) of these 101 patients died at MSKCC. CONCLUSION:Dyspnea is a common and important symptom in cancerpatients for which SOx traditionally has had no clear basis except in select cases of hypoxia and patient preference. Our institutional experience with HHFNOx contributes to the understanding of the applications and challenges surrounding the use of new medical devices in the cancer population. Physiologic and quality-of-life benefits of HHFNOx compared with traditional oxygen delivery methods should be studied prospectively.
Authors: Amir Qaseem; Vincenza Snow; Paul Shekelle; Donald E Casey; J Thomas Cross; Douglas K Owens; Paul Dallas; Nancy C Dolan; Mary Ann Forciea; Lakshmi Halasyamani; Robert H Hopkins; Paul Shekelle Journal: Ann Intern Med Date: 2008-01-15 Impact factor: 25.391
Authors: Amy P Abernethy; Christine F McDonald; Peter A Frith; Katherine Clark; James E Herndon; Jennifer Marcello; Iven H Young; Janet Bull; Andrew Wilcock; Sara Booth; Jane L Wheeler; James A Tulsky; Alan J Crockett; David C Currow Journal: Lancet Date: 2010-09-04 Impact factor: 79.321
Authors: Sebastiano Mercadante; Antonello Giarratano; Andrea Cortegiani; Cesare Gregoretti Journal: Support Care Cancer Date: 2017-04-25 Impact factor: 3.603
Authors: Marcel Simon; Stephan Braune; Daniel Frings; Ann-Kathrin Wiontzek; Hans Klose; Stefan Kluge Journal: Crit Care Date: 2014-12-22 Impact factor: 9.097
Authors: Oriol Roca; Gonzalo Hernández; Salvador Díaz-Lobato; José M Carratalá; Rosa M Gutiérrez; Joan R Masclans Journal: Crit Care Date: 2016-04-28 Impact factor: 9.097