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Non-invasive ventilation for a rapidly deteriorating palliative patient
  1. Elizabeth Green,
  2. Louisa Stockton and
  3. Emma De Winton
  1. Oncology Department, Royal United Hospital, Bath, UK
  1. Correspondence to Dr Elizabeth Green, Royal United Hospital, Bath BA1 3NG, UK; elliegreen1{at}nhs.net

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Background

Non-invasive ventilation (NIV) is a further option for oxygen delivery to an acutely unwell patient. However it is often overlooked as a tool within palliation. We report a case of a young woman presenting in extremis with type 1 respiratory failure.

Case presentation

A 39-year-old Caucasian woman presented to the emergency department with type 1 respiratory failure requiring 9 L of oxygen to maintain her saturations. This followed a 1-month history of breathlessness and pleuritic chest pain. Her medical history included anxiety, depression, smoking of both tobacco and marijuana, as well as pregnancy at 16 years old.

Clinical examination on admission revealed two masses in the right breast, a clear chest and upper abdominal tenderness. Chest X-ray displayed multiple lesions throughout both lungs and a left pleural effusion. CT scan revealed an extensive metastatic disease affecting the lung, liver, spleen, kidneys, and subcutaneous tissue in the chest, left flank and breast (figure 1). A prominent 12 cm mass in the lingula and marked emphysema raised concern for a lung primary.

Figure 1

CT image showing metastatic lesions in multiple organs.

Aside from microcytic anaemia and a mildly raised alanine transaminase, routine blood tests were unremarkable. A pregnancy test was positive and blood lactate dehydrogenase, human chorionic gonadotropin and Ca125 proteinlevels were markedly raised. One of the breast lesions was biopsied …

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