Hui David, Hernandez Farley, Urbauer Diana, Thomas Saji, Lu Zhanni, Elsayem Ahmed, Bruera Eduardo
Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA.
Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas, USA.
Oncologist. 2021 May;26(5):e883-e892. doi: 10.1002/onco.13622. Epub 2020 Dec 15.
The effect of high-flow oxygen (HFOx) and high-flow air (HFAir) on dyspnea in nonhypoxemic patients is not known. We assessed the effect of HFOx, HFAir, low-flow oxygen (LFOx), and low-flow air (LFAir) on dyspnea.
SUBJECTS, MATERIALS, AND METHODS: This double-blind, 4×4 crossover clinical trial enrolled hospitalized patients with cancer who were dyspneic at rest and nonhypoxemic (oxygen saturation >90% on room air). Patients were randomized to 10 minutes of HFOx, HFAir, LFOx, and LFAir in different orders. The flow rate was titrated between 20-60 L/minute in the high-flow interventions and 2 L/minute in the low-flow interventions. The primary outcome was dyspnea numeric rating scale (NRS) "now" where 0 = none and 10 = worst.
Seventeen patients (mean age 51 years, 58% female) completed 55 interventions in a random order. The absolute change of dyspnea NRS between 0 and 10 minutes was -1.8 (SD 1.7) for HFOx, -1.8 (2.0) for HFAir, -0.5 (0.8) for LFOx, and - 0.6 (1.2) for LFAir. In mixed model analysis, HFOx provided greater dyspnea relief than LFOx (mean difference [95% confidence interval] -0.80 [-1.45, -0.15]; p = .02) and LFAir (-1.24 [-1.90, -0.57]; p < .001). HFAir also provided significantly greater dyspnea relief than LFOx (-0.95 [-1.61, -0.30]; p = .005) and LFAir (-1.39 [-2.05, -0.73]; p < .001). HFOx was well tolerated. Seven (54%) patients who tried all interventions blindly preferred HFOx and four (31%) preferred HFAir.
We found that HFOx and HFAir provided a rapid and clinically significant reduction of dyspnea at rest in hospitalized nonhypoxemic patients with cancer. Larger studies are needed to confirm these findings (Clinicaltrials.gov: NCT02932332).
This double-blind, 4×4 crossover trial examined the effect of oxygen or air delivered at high- or low-flow rates on dyspnea in hospitalized nonhypoxemic patients with cancer. High-flow oxygen and high-flow air were significantly better at reducing dyspnea than low-flow oxygen/air, supporting a role for palliation beyond oxygenation.
高流量氧气（HFOx）和高流量空气（HFAir）对非低氧血症患者呼吸困难的影响尚不清楚。我们评估了HFOx、HFAir、低流量氧气（LFOx）和低流量空气（LFAir）对呼吸困难的影响。
受试者、材料与方法：这项双盲、4×4交叉临床试验纳入了因癌症住院且静息时呼吸困难且非低氧血症（室内空气下氧饱和度>90%）的患者。患者被随机分配以不同顺序接受10分钟的HFOx、HFAir、LFOx和LFAir治疗。高流量干预的流速在20 - 60升/分钟之间滴定，低流量干预的流速为2升/分钟。主要结局是呼吸困难数字评定量表（NRS）“此刻”评分，其中0 =无，10 =最严重。
17名患者（平均年龄51岁，58%为女性）以随机顺序完成了55次干预。0至10分钟内呼吸困难NRS的绝对变化，HFOx为-1.8（标准差1.7），HFAir为-1.8（2.0），LFOx为-0.5（0.8），LFAir为-0.6（1.2）。在混合模型分析中，HFOx比LFOx能更有效地缓解呼吸困难（平均差值[95%置信区间]-0.80[-1.45, -0.15]；p = 0.02），也比LFAir更有效（-1.24[-1.90, -0.57]；p < 0.001）。HFAir同样比LFOx（-0.95[-1.61, -0.30]；p = 0.005）和LFAir（-1.39[-2.05, -0.73]；p < 0.001）能更显著地缓解呼吸困难。HFOx耐受性良好。13名（54%）盲目尝试了所有干预措施的患者更喜欢HFOx，4名（31%）更喜欢HFAir。
我们发现HFOx和HFAir能使住院的非低氧血症癌症患者静息时的呼吸困难迅速且在临床上显著减轻。需要更大规模的研究来证实这些发现（Clinicaltrials.gov：NCT02932332）。
这项双盲、4×4交叉试验研究了高流量或低流量输送的氧气或空气对住院的非低氧血症癌症患者呼吸困难的影响。高流量氧气和高流量空气在减轻呼吸困难方面显著优于低流量氧气/空气，这支持了其在除氧合作用之外的姑息治疗中的作用。
