BiPAP-Vapotherm RCT

Inclusion Criteria:

1. Diagnosis of advanced cancer, defined as locally advanced, recurrent, or metastatic disease
2. Persistent dyspnea, defined in this study as dyspnea at rest with an average intensity level \>=3/10 on the numeric rating scale for at least 1 week and just prior to study initiation despite supplemental oxygen for at least 30 minutes
3. Dyspnea judged clinically to be predominantly due to the underlying malignancy, with or without obstructive lung disease
4. Inpatient at MD Anderson Cancer Center
5. Able to communicate in English
6. Expected life expectancy \>1 week
7. Age 18 or older

Exclusion Criteria:

1. Hypoxia (i.e., O2 saturation \<90%) despite supplemental oxygen at 15 L/min
2. Hemodynamic instability (systemic blood pressure (SBP) \<90 mmHg) within 1 hour of study initiation
3. Comatose state or delirium, as indicated by a Memorial Delirium Assessment Scale score of 13 or higher
4. Uncontrolled arrhythmia as per clinical record at enrollment
5. Upper GI bleeding within 2 weeks of enrollment
6. Esophageal rupture at enrollment
7. Upper airway obstruction at enrollment
8. History of facial trauma within 2 weeks of enrollment
9. Facial, upper airway, or GI surgery within 2 weeks of enrollment
10. Thoracic surgery within 6 weeks of enrollment
11. Excessive airway secretions interfering with BiPAP administration
12. Undrained pneumothorax at enrollment
13. Partial or complete small bowel obstruction or severe nausea/vomiting (Edmonton symptom assessment scale nausea \>7/10) within 48 hours of enrollment
14. Hemoglobin \<8 g/dL at the time of enrollment (blood drawn within past 2 weeks)
15. Acute exacerbation of chronic obstructive pulmonary disease (COPD) or heart failure within 1 week of enrollment by history or physical
16. Known CO2 retainers as per clinic station
17. Known pulmonary hypertension as per clinic station
18. Unwillingness to provide consent