Non-invasive Ventilation in Adult Cancer Patients With Acute Respiratory Failure: A Systematic Review of Clinical Outcomes and Predictors of Failure
Bibliographic record
Abstract
Acute respiratory failure (ARF) is a leading cause of unexpected admissions to the ICU in adults with active solid or haematologic cancer. Early trials highlighted some benefits of non-invasive ventilation (NIV) delivered with supplemental oxygen versus conventional oxygen. Whether this is still maintained in the high-flow nasal cannula (HFNC) era is doubtful. Therefore, a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided, scenario-based systematic review was conducted to evaluate the effectiveness and harms of NIV versus oxygen/HFNC and to identify predictors and outcomes of NIV failure in adult cancer patients with ARF. Searches on PubMed from inception to 31 August 2025, Scopus, and the Cochrane Library from 2010 to 31 August 2025 were completed. In this review of trials and studies, primary outcomes were NIV failure, defined as intubation during the index episode, and in-hospital mortality. Secondary outcomes were length of stay, complications, and predictors of NIV failure. Two reviewers screened, extracted, and assessed risk of bias using Cochrane Risk of Bias 2 (RoB 2) and the Newcastle-Ottawa Scale. We did not perform a formal meta-analysis, and studies were compared qualitatively. Twenty-six studies met the inclusion criteria, including four randomised trials and 22 cohorts, with a pooled sample of approximately 12,000 patients. In de novo hypoxemic respiratory failure, the largest recent trial and adjusted cohorts showed no decline in intubation or mortality rates with early NIV versus oxygen or high-flow nasal cannula. In cancer-related acute respiratory distress syndrome (ARDS), a form of ARF, NIV failure was common at about 60% to 80% and greatly linked to death. In the case of NIV failure, independent predictors of failure included shock, lower arterial oxygen partial pressure to inspired oxygen fraction ratio (PaO₂/FiO₂), invasive fungal infection, higher severity scores, and undetermined aetiology. However, in cases of cancer and acute respiratory failure with cardiac dysfunction, observational data suggested lower ICU mortality with early NIV. Limitations of this review include heterogeneity, residual confounding, and variable protocols. To conclude, benefits of NIV in cancer-related ARF are context dependent. There is no clear advantage of NIV over HFNC/oxygen in de novo hypoxemia. In addition, high failure risk in ARDS with NIV mandates vigilant escalation. A context-specific NIV approach rather than a blanket one is highly recommended in the HFNC era.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.044 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.013 |
| Bibliometrics | 0.007 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".