BiPAP-Vapotherm RCT

Device A is designed to get more air in and out of their lungs without using as much effort
as regular breathing. The air is given through a mask, and the amount of air can be set to
different levels.

Device B is designed to deliver air in and out of the lungs. The air is warmed, filtered
for bacteria, and then delivered through the nose using a tube under the nostrils.

Device C is designed to deliver air in and out of the lungs. The air is given through a
mask, and the amount of air can be set to different levels.

Study Groups and Device Use:

If you are found to be eligible to take part in this study, you will be randomly assigned
(as in the roll of dice) to 1 of 3 groups:

- If you are in Group 1, you will receive air through Device A for 1 hour, and then on an
"as needed" basis for up to 4 hours. Then you will receive air through Device B for up
to 30 minutes, followed by 30 minutes using Device C.

- If you are in Group 2, you will receive air through Device B for 1 hour, and then on an
as needed basis for up to 4 hours. Then you will receive air through Device A for up
to 30 minutes, followed by 30 minutes using Device C.

- If you are in Group 3, you will receive air through Device C for 1 hour, and then on an
as needed basis for up to 4 hours. Then you will receive air through Device A for up
to 30 minutes, followed by 30 minutes using Device B.

The study staff will help you use the devices. The maximum time allowed using the 3 devices
is 6 hours total.

During the "as needed" use period (4 hours), you will switch between the device you were
assigned to and the same air delivery device and oxygen level that you were using just
before you started the study.

Study Visit:

During your study visit, the following tests and procedures will be performed:

- From your medical record, the study staff will collect information about your age, sex,
race, disease type, how well you are able to perform the normal activities of daily
living, any drugs you are taking, and possible causes of shortness of breath.

- You will complete 2 questionnaires. The first asks about breathing symptoms, and the
second asks about other symptoms you may be having. It should take about 15 minutes to
complete these questionnaires.

- Your heart rate, breathing rate, and blood pressure will be recorded.

- The level of air you breathe out will be recorded using a measuring device on your
chest.

- Before and after using the devices, you will be asked how hard it is to catch your
breath and about any side effects you may be having.

- At the end of the visit, you will fill out a questionnaire that asks about which device
you prefer. It should take about 5 minutes to complete this questionnaire.

Length of Study:

You will be on this study for up to 6 hours. You will be taken off study and the device
will be stopped if intolerable side effects occur while using a study device.

This is an investigational study. The 3 breathing devices are commercially available and
FDA approved for delivering oxygen when medically needed, including in cancer patients. It
is investigational to collect information from patients to rate how well the study devices
may affect shortness of breath.

Up to 90 patients will be enrolled in this study. All will be enrolled at MD Anderson.

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