The Science Journal of the American Association for Respiratory Care

2002 OPEN FORUM Abstracts

PATTERNS OF HELIUM-OXYGEN (HELIOX) USAGE IN THE CRITICAL CARE ENVIRONMENT.

John W. Berkenbosch1, Ryan E. Grueber2, Gavin R. Graff1, Joseph D. Tobias1,3, Departments of Child Health1, Respiratory Therapy2, and Anesthesiology3, The University of Missouri-Columbia, Columbia, MO, USA.

INTRODUCTION: Interest continues to grow regarding applications of helium-oxygen (heliox) therapy for both upper and lower airway disorders. Reports to date have focussed on the safety and effectiveness of helium for specific disease processes but no data exist regarding general patterns of heliox use. This report describes the patterns of heliox use in the tertiary care critical care environment of an academic medical center.

Methods: All patients receiving heliox therapy over a 4 year period in 7 critical care units of our institution were enrolled. Data collected included patient demographics and location, indication for heliox use, method of delivery, duration of use and the rationale for it?s continuation. Comparisons between use for upper versus lower airway disorders and between pediatric (£18 years) versus adult applications were performed by chi-squared analysis with a contingency table. A p value < 0.05 was considered significant.

Results:üEighty-nine patients, aged 17.4±20.9 years (range 14 days to 82 years), received heliox for 30.5±44.6 hours (range 0.1-256 hours) on 92 occasions. Pediatric applications accounted for 73% of heliox use. Heliox use increased progressively throughout the study period, primarily in the adult population where use almost doubled. Forty-three (47%) applications were for upper airway obstruction (UAO), most commonly post-extubation stridor (n=22), static encephalopathy (n=7), and croup (n=6). The mean duration of use of 15.8±17.0 hours. Heliox was delivered by simple face mask (n=40), aerosol face mask (n=2), or CPAP (n=1). A positive response was perceived in 22/27 (82%) children versus 6/16 (38%) of adults (p<0.001). Ten patients (3 children, 7 adults) required endotracheal intubation. Forty-nine (53%) applications were for lower airway disorders, most commonly status asthmaticus (n=38) and Respiratory Syncytial virus (RSV) bronchiolitis (n=4). The mean duration of use of 43.2±56.3 hours (p<0.005 compared with duration with use for UAO). Heliox was delivered by aerosol face mask (n=30), simple face mask (n=17) mechanical ventilator (n=6) or BiPAP (n=1). A positive response was perceived in 34/40 (85%) children and 7/9 (78%) adults (p=NS). Four patients (2 children, 2 adults) required endotracheal intubation. Thirty-two patients received heliox at an initial FiO2 of ³0.45. In 16 of these (50%), FiO2 was weaned by a mean of 0.13±0.05 within one hour of heliox initiation.

Conclusions: This is the first series describing patterns of heliox use in the tertiary care critical care environment of an academic medical center. Heliox appeared to be far more effective for treating UAO in the pediatric compared to the adult age group. While heliox was continued for a longer duration for lower airway disorders, the concurrent use of other therapies makes determination of a positive response in these patients more difficult. The rapid decrease in FiO2 in many patients receiving heliox at relatively high initial FiO2 values suggests that heliox may be more beneficial at higher FiO2 values than previously thought. As a benign and relatively inexpensive therapy, heliox use will likely become increasingly attractive for the treatment of many respiratory disorders, despite limited data regarding efficacy in certain scenarios.

OF-02-064

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