The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

A SURVEY OF HELIOX USE IN ACADEMIC EMERGENCY DEPARTMENTS IN THE UNITED STATES

Jessica M. Pang1, Dean R. Hess2.3, Carlos A. Camargo1,3



Background: Heliox has been used for many years in the care of selected patients with partial airway obstruction. Despite considerable anecdotal experience suggesting benefit in some patients, there is little high level evidence supporting its use. The purpose of this study was to determine the frequency of use, and barriers to use, of heliox for adult patients with acute asthma, COPD exacerbation, and stridor in academic emergency departments (EDs).

Methods:
A survey instrument was developed and pilot tested by the authors, and then sent to 1 emergency physician (MD) and 1 respiratory therapist (RT) at the 132 medical centers with an emergency medicine residency. The survey was conducted by the Emergency Medicine Network (EMNet; www.emnet-usa.org). Results: We received a response from 105 sites (80%). Only 66% report use of heliox in the ED. Of these, 46% report that equipment to administer heliox is readily available in the ED and only 30% reported that heliox therapy can be initiated in < 10 min. Heliox is used infrequently for asthma, COPD, and stridor (73%, 96%, and 67% report use in < 10% of these patients, respectively). Whereas 72% of RTs report that they are very familiar with heliox, only 6% of MDs report that they are very familiar with this therapy (P < .001). Although 97% report that RT is primarily responsible for heliox set-up, in only 38% is RT always available in the ED. When asked about their perceptions of the utility of heliox, 38% report that heliox often helps with stridor, 23% report that it often helps with asthma, and 9% report that if often helps with COPD (P < .001). Related to technical approaches, 20% use a commercially available system, 86% administer bronchodilators with heliox, and 48% administer heliox with noninvasive ventilation.

Conclusions:
Heliox is not commonly used in the EDs of academic medical centers in the United States. The minority of respondents report that they believe heliox often helps for acute asthma, COPD exacerbation, or stridor. Consistent with available evidence, the perception of utility is lowest for COPD exacerbation. Barriers to greater use of heliox in the ED include MD familiarity and availability of RT and equipment in the ED. For all conditions, however, uncertainty about therapeutic benefits remains a major challenge. (This research supported, in part, by Respironics.)