HWN Suggests

Heliox – Part of the Kitchen Sick

I consider Heliox in any patient that has severe increased work of breathing and who hasn’t improved with 1st and 2nd line therapies. The patient who comes in looking like the need to be intubated emergently is not the patient that gets Heliox first… they get intubated. But the kid who is still in severe respiratory distress after your 1st line meds and maneuvers and is still looking like they have some residual fight let in them, then Heliox may give them the edge they need to get through this without a big piece of plastic in their airway. It is in the Kitchen Sick with other fun things like Magnesium and BiPap.

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Featured

 Heliox in the Pediatric Emergency Department

Clearly there isn’t a preponderance of evidence to suggest that heliox is a game changing treatment for asthma, bronchiolitis or croup. I think there are situations where it makes a lot of sense, but the evidence just isn’t there.

Articles of Interest

A Review of the use of Heliox in the Critically Ill

Interest in the use of helium for medical purposes comes from the fact that helium is markedly less dense than both oxygen and nitrogen.

From a Barky Cough to a Squeaky Voice: Heliox for Croup

While heliox theoretically should decrease work of breathing in croup, the evidence is lacking.

Heliox in severe asthma

Expensive, Contraindicated in hypoxemic patients, Paucity of large prospective randomized trials.

Helium-oxygen (heliox) treatment for children with croup

Given the very limited available evidence, uncertainty remains regarding the effectiveness and safety of heliox. Heliox may not be more effective than 30% humidified oxygen for children with mild croup, but may be beneficial in the short term for children with moderate croup treated with dexamethasone.

In the Midst of Turbulence, Heliox Kept Her Alive

Heliox (70% helium and 30% oxygen) was delivered at 16 L/minute via a nonrebreather facemask. Thirty minutes after treatment initiation, the patient had reduced dyspnea and was able to speak in full sentences, and her respiratory rate had fallen to 14 breaths/minute. The patient ultimately did well and did not require intubation. Fifteen hours later, she was able to ambulate without dyspnea.

The use of heliox in critical care

This paper reviews the medical use of helium oxygen mixture in obstructive airway disease in patients with croup, narrow endotracheal tubes (ETTs), respiratory distress syndrome, asthma, bronchiolitis, as well as patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and acute lung injury.

Thinking Outside Intubation | The Pros and Cons of Heliox Therapy

The major benefit of heliox comes from its lower density and improvement in flow dynamics and therefore, is primarily used for treatment of upper airway obstructions (intrinsic and extrinsic), croup, and post-extubation stridor.

Why We Do What We Do: HELIOX

HELIOX has been shown to be very effective in treating COPD in the adult literature. The article suggests that it is also effective in the pediatric populations, especially in obstructive pathology including: croup, bronchiolitis, status asthmaticus, angioedema, post extubation subglottic edema, etc.

Resources

Life in the Fastlane

anecdotal evidence of avoiding need for intubation in upper airway obstruction, little evidence of benefit in lower airways obstructive lung disease – the common theme is that heliox is a temporising measure but is not a treatment.