The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

ADMINISTRATION OF HELIOX AND BRONCHODILATOR AEROSOL VIA HIGH FLOW NASAL CANNULA IN A SEVERE ASTHMATIC

Patricia Dailey1



Introduction: Benefit of administering heliox1 and aerosol2 via high flow nasal cannula (HFNC) have not been reported separately. This combination was used to treat severe asthmatic refractory to standard heliox and bronchodilator therapy.

Case Summary:
A 56 year old woman admitted for severe asthma exacerbation deteriorated despite treatment with intravenous steroids, heliox therapy delivered via NRB and 2.5 mg of albuterol Q4° delivered with an Misty Max 10 TM (Airlife) SVN via mouthpiece and powered by 8 lpm heliox using a wye adaptor placed in-line with the NRB mask so that heliox therapy would remain uninterrupted. 36 hours post admission significant use of accessory muscles, breath sounds barely audible, RR >44, with SaO2 94%. Intubation appeared imminent.

HFNC (Fisher & Paykel Optiflow®) with 80/20 Heliox at 15 lpm initiated. Immediate improvement observed with vocal alteration, improved SaO2, aeration, and subjective relief. A vibrating mesh nebulizer (Aeroneb Solo®: Aerogen) inline post-humidifier to administered albuterol (2.5 mg Q4) with increased aeration post-tx compared to SVN. The patient continued to show improvement and within 24 hours she was weaned from the heliox and the HFNC.

Discussion:
This is the first report of combining delivery of heliox and albuterol via nasal prongs in treatment of severe asthma. In contrast to the NRB, the HFNC delivered sufficient heliox to alter vocal changes and provide symptomatic relief. The administration of albuterol via nasal cannula provided greater symptomatic relief than the standard SVN via MP.

References:

1. Meyer R. Helium/oxygen (Heliox) in the Emergency room: Comparison of Open System via High Flow Cannula vs. Closed System. Respir Care 2002 September. 47(9)
2. Bhashyam A, Wolf M, Marcinkowski A, Saville A, Carcillo J, Corcoran T. Aerosol Delivery through Nasal Cannulas: An In Vitro Study. J Aerosol Med 2008 December Vol. 21(2)