Noninvasive positive-pressure ventilation in patients with malignancy.

Noninvasive positive-pressure ventilation (NIPPV) is now accepted as the treatment of choice for subgroups of patients with acute respiratory failure. Noninvasive positive-pressure ventilation has traditionally not been considered in the management strategy of patients with malignancy; however, this mode of ventilatory support may be appropriate in some specific situations. Noninvasive positive-pressure ventilation is the preferred initial mode of ventilatory support in patients with hematologic malignancies or after bone marrow transplantation who develop acute respiratory failure. In these patients, NIPPV should be initiated early; severe respiratory distress and altered mental status require conventional mechanical ventilation. Noninvasive positive-pressure ventilation should be considered in select patients with cancer who develop respiratory failure and have a do-not-intubate code status. In rare instances, NIPPV may have a role in treating patients with advanced cancer who have intractable dyspnea; however, NIPPV should not be used for the sole purpose of prolonging life in patients with terminal respiratory failure.