Open Access Short Communication
Ramos et al., J Cancer Sci Ther 2019, 11:4
DOI: 10.4172/1948-5956.1000593
J Cancer Sci Ther, an open access journal
ISSN: 1948-5956
Volume 11(4) 104-105 (2019) - 104
Journal of
Cancer Science & Therapy
J
o
u
r
n
a
l
o
f
C
a
n
c
er
S
c
i
e
n
c
e
&
T
h
e
r
a
p
y
ISSN: 1948-5956
*Corresponding author: César Fonseca, Doctoral Student, Department of
Nursing, Nursing Research and Development Unit, University of Lisbon, Lisbon,
Portugal, Tel: +70013046851; E-mail: cesar.j.fonseca@gmail.com
Received March 13, 2017; Accepted April 02, 2019; Published April 09, 2019
Citation: Ramos AF, Tavares AP, Mendes F, Lopes M, Parreira P, et al. (2019)
Non-Invasive Ventilation in Control of Dyspnea in Patient with Oncological Disease:
Among Nursing Intervention. J Cancer Sci Ther 11: 104-105. doi: 10.4172/1948-
5956.1000593
Copyright: © 2019 Ramos AF, et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited.
Keywords: Non-invasive ventilation; Dyspnea; Oncological disease;
Chronic diseases; Health
Introduction
e person with cancer oſten experiences symptomatic disruption,
in which dyspnea is an inductor symptom of high levels of anxiety
and fatigue [1,2], responsible for the demand for health care. Dyspnea
is one of the most prevalent symptoms with progression of oncologic
disease, especially in advanced stages, with an oscillating incidence
between 48 and 70%, reaching 90% in terminal situations. Dyspnea
can be interpreted as a subjective sensation of shortness of breath,
difficulty in breathing or obstruction of the airway, referred to as a
disturbing sensation resulting from increased respiratory work and use
of accessory muscles, being a source of great suffering for the person
and family members/caregivers [3].
Decreased tolerance to physical effort, results in a sense of loss of
autonomy and limitation; on the other hand, it may come from anxiety,
anguish and emotional distress, related to the feeling of closeness to
the end of life. Shoemaker [4] report that in more than 25% of people
who experience dyspnea, there is no association with lung neoplasia or
pulmonary involvement. e etiology of dyspnea, in the person with
oncological disease, is multifactorial, since it derives from factors of
physical, psychic, social and spiritual nature.
e identification of dyspnea is based on the appreciation of the
discourse of the patient and his relatives/caregivers, as well as must
be supported in the objective examination of the nurse. e different
causes of dyspnea can generally be grouped into three groups: direct or
indirect consequence of local invasion or metastatic dissemination of
neoplasm; consequence of cancer therapy; or other physiological causes.
With regard to the first etiology, it may result from airway obstruction,
pulmonary parenchyma invasion, carcinomatous lymphoblasts, pleural
effusions, superior vein cava syndrome, pericardial effusion, ascites
with abdominal distension and elevation of the diaphragm. Regarding
the iatrogenic cause, stands out the surgery with amputation of the
pulmonary parenchyma, radiotherapy, with secondary pulmonary
fibrosing lesions, chemotherapy with cytostatic enhancers of pulmonary
fibrosis or myocardial lesion (bleomycin and adriamycin). Other causes
include cachexia with respiratory muscle weakness, anemia, heart
failure, respiratory failure, pulmonary thromboembolism, metabolic
acidosis, acute pulmonary edema, bronchospasm, pneumothorax,
thoracalgia and anxiety [3,5].
In the control of dyspnea, temporary use of noninvasive
ventilation (NIV) in Continuous positive airway pressure (CPAP)
or Bi-level positive pressure (BiPAP) may be indicated to relief some
severe reversible conditions [6]. In recent decades, NIV has been
the gold standard for the treatment of acute respiratory failure, in
which multiple randomized studies have demonstrated its positive
results in reducing the need for endotracheal intubation, decreasing
mortality rate, morbidity and reducing length of stay at intensive care
and hospitalization time [6-8]. e use of NIV decreases the need to
use high-speed oxygen therapy and tracheostomy, with evidence of
effectiveness in people with chronic obstructive pulmonary disease,
asthma, who underwent transplantation, in conditions of neutropenia
and with neuromuscular diseases [9]. However, the effectiveness of NIV
depends on the severity and type of respiratory pathology, the person's
health conditions and the nurses' level of expertise, on the surveillance
and prevention of complications [6].
Discussion
NIV is only recommended for mild to moderate respiratory failure
and with low pH repercussions (pH=7.30 to 7.35) and is advised
against altered state of consciousness, decreased pharyngeal reflex,
recent esophagogastric surgery, evidence of myocardial ischemia or in
the presence of ventricular arrhythmias [9]. e use of NIV may also
lead to possible complications, including loss of skin or nasal integrity,
abdominal distension, risk of aspiration of gastric contents, sleep
pattern disturbances and conjunctivitis [10].
e nursing intervention in the appropriate choice of interface allows
the success of the technique and should be based on the anatomical
characteristics of the patient, cutaneous integrity, ventilatory needs,
namely, inspiratory/expiratory pressure and times of use. In this sense,
the nurse plays a fundamental role in monitoring the effectiveness of
Non-Invasive Ventilation in Control of Dyspnea in Patient with Oncological
Disease: Among Nursing Intervention
Ana Filipa Ramos
1
, Ana Patrícia Tavares
1
, Felismina Mendes
2
, Manuel Lopes
2
, Pedro Parreira
3
and César Fonseca
4
*
1
Hospital of Medium Tejo, Portugal
2
University of Évora, Évora, Portugal
3
Coimbra Nursing School, Portugal
4
Department of Nursing, Nursing Research and Development Unit, University of Lisbon, Lisbon, Portugal
Abstract
Demographic changes, such as aging and unhealthy lifestyles have contributed to the prevalence of chronic diseases,
including cerebrovascular and oncological diseases. Currently, people have one or more diseases simultaneously,
which requires new models of care, able to responding at the increased complexity in health. Polpatology has profound
implications for self-care, autonomy and the use of health services.