Non-Invasive Ventilation in Onco-Critical Care: Safety, Efficacy, and Clinical Outcomes

Abstract

Objective: To evaluate the safety, efficacy, and outcomes of non-invasive ventilation (NIV) in a predominantly oncology intensive care unit (ICU) population and identify factors associated with NIV success and failure.

Study Design: This study is a retrospective observational cohort.

Place and Duration of Study: Oncology Critical Care Unit, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from February to December 2025.

Methodology: Using purposive sampling, 100 ICU patients with acute respiratory failure requiring NIV were included. Data on demographics, indications, ventilatory parameters, complications, arterial blood gas (ABG) response, and outcomes were collected.

Results: The cohort comprised 80% oncology and 20% non-oncology patients. Mean age was 46.3 ± 20.7 years, and 56% were male. The most common indications for NIV were hypoxemic respiratory failure related to oncological conditions and acute exacerbation of chronic obstructive pulmonary disease, followed by pneumonia and pulmonary oedema. NIV intolerance occurred in 22% of patients and complications in 15%. ABG improvement was observed in 78%, while NIV successfully avoided intubation in 64% of cases. Intubation was required in 36% and was associated with higher mortality than successful NIV use (63.9% vs. 12.5%). Overall, ICU mortality was 28%.

Conclusion: NIV is a safe and effective treatment for acute respiratory failure in a predominantly oncology ICU population. Early initiation, favorable ABG response, and good tolerance were associated with NIV success, whereas severe hypoxemia and intolerance were linked to NIV failure.