Heliox delivered by high flow nasal cannula improves oxygenation in infants with respiratory syncytial virus acute bronchiolitis

Seliem, Wael; Sultan, Amira M.

doi:10.1016/j.jped.2017.04.004

Cited by 15 publications

(9 citation statements)

References 18 publications

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“…Future studies should determine whether heliox might help to improve low StO 2 in patients with severe respiratory failure. Although there are studies on heliox MV only single publications report on non-invasive respiratory support and the influence of the therapy on oxygenation in infants 27 , 28 . In the presented study the increase in SpO 2 values after 1 h of heliox was statistically significant but very subtle—most likely of limited clinical importance.…”

Section: Discussionmentioning

confidence: 99%

Effects of heliox and non-invasive neurally adjusted ventilatory assist (NIV-NAVA) in preterm infants

Neumann-Klimasińska

Merritt

Beck

et al. 2021

Sci Rep

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Due to its unique properties, helium–oxygen (heliox) mixtures may provide benefits during non-invasive ventilation, however, knowledge regarding the effects of such therapy in premature infants is limited. This is the first report of heliox non-invasive neurally adjusted ventilatory assist (NIV-NAVA) ventilation applied in neonates born ≤ 32 weeks gestational age. After baseline NIV-NAVA ventilation with a standard mixture of air and oxygen, heliox was introduced for 3 h, followed by 3 h of air-oxygen. Heart rate, peripheral capillary oxygen saturation, cerebral oxygenation, electrical activity of the diaphragm (Edi) and selected ventilatory parameters (e.g., respiratory rate, peak inspiratory pressure) were continuously monitored. We found that application of heliox NIV-NAVA in preterm infants was feasible and associated with a prompt and significant decrease of Edi suggesting reduced respiratory effort, while all other parameters were stable throughout the study, and had similar values during heliox and air-oxygen ventilation. This therapy may potentially enhance the efficacy of non-invasive respiratory support in preterm neonates and reduce the number of infants progressing to ventilatory failure.

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Section: Discussionmentioning

confidence: 99%

Effects of heliox and non-invasive neurally adjusted ventilatory assist (NIV-NAVA) in preterm infants

Neumann-Klimasińska

Merritt

Beck

et al. 2021

Sci Rep

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“…Of these, 22 were further assessed in the full-text phase. Six RCTs were found, [12][13][14][15]17,18 and all of these were included in the final analysis. We did not find any additional studies from other sources to be included (the references of the included studies were checked; see Figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…14,15 A previous meta-analysis conducted in 2015 stated that heliox does not increase the rate of discharge from the emergency department, decrease the rates of intubation, but it may decrease the length of stay in infants severe respiratory distress and receiving CPAP, but it must be noted that the quality of the included studies was classified as low and the meta-analysis included both parallel and crossover designed studies. 16 Since then, other studies on the use of heliox as a treatment for bronchiolitis 17,18 have been published. Thus, we decided to update the evidence summary.…”

Section: Introductionmentioning

confidence: 99%

Helium–oxygen in bronchiolitis—A systematic review and meta‐analysis

Kuitunen

Kiviranta

Sankilampi

et al. 2022

Pediatric Pulmonology

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Introduction Bronchiolitis is common reason for infant hospitalization. The aim of our systematic review and meta‐analysis was to evaluate helium–oxygen (heliox) in bronchiolitis. Methods We screened 463 studies, assessed 22 of them, and included six randomized controlled trials. Primary outcomes were the need for continuous positive airway pressure (CPAP) or intubation, hospitalization duration, and change in the modified Woods Clinical Asthma Scale (M‐WCAS). We calculated mean differences with 95% confidence intervals (CIs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes. Results Six studies (five double‐ and one single‐blinded) with 560 infants were included. The risk of bias was high in one, moderate in four, and low in one. The RR for the need for CPAP (three studies) was 0.87 (CI: 0.56–1.35), and for intubation (four studies) was 1.39 (CI: 0.53–3.63), heliox compared to air–oxygen. The hospital stay (four studies) was 0.25 days longer (CI: −0.22 to 0.71) in the heliox group. The mean decrease in M‐WCAS from the baseline (three studies) was 1.90 points (CI: 1.46–2.34) greater in the heliox group. Conclusion We found low‐quality evidence that heliox does not reduce the need for CPAP, intubation, or length of hospitalization for bronchiolitis. Based on the M‐WCAS scores, heliox seems to relieve respiratory distress symptoms rapidly after its initiation. The included studies had high heterogeneity in their methods and included relatively mild cases of bronchiolitis. A larger randomized controlled trial with more severe cases of bronchiolitis with enough power to analyze the need for intubation is needed in the future.

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“…Heliox did not reduce the risk of intubation, rate of emergency department discharge or length of treatment for respiratory distress. However, in infants on nCPAP right from the start helium-oxygen reduced the length of treatment: MD −0.76 days (95% CI −1.45 to −0.08, one trial, 21 infants, low quality evidence) ( 35 ). Chowdury et al concluded that “Heliox therapy does not reduce length of treatment unless given via a tight-fitting facemask or CPAP” ( 36 ).…”

Section: Clinical Applications Of Helioxmentioning

confidence: 99%

Neonatal Applications of Heliox: A Practical Review

2022

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Heliox is a mixture of helium and oxygen that may be utilized as an alternative to air-oxygen during the ventilatory support in the neonate. Special physical properties of Heliox, particularly low density, allow for improved gas flow and diffusion. First reports of Heliox use in the pediatric population were published in 1930s; however, this therapy has never gained widespread popularity despite its described beneficial effects. Historically, this was largely due to technical challenges associated with Heliox ventilation that significantly limited its use and realization of large-scale clinical trials. However, nowadays several commercially available ventilators allow easy and safe ventilation with both conventional and non-invasive modes. In the era of minimally invasive respiratory interventions in the newborn Heliox could be seen as a therapy that may potentially decrease the risk of non-invasive ventilation failure. This review presents pathophysiologic rationale for the use of Heliox in the newborn, and summarizes available data regarding applications of Heliox in the setting of neonatal intensive care unit based on clinical studies and findings from animal models. Mechanisms of action and practical aspects of Heliox delivery are thoroughly discussed. Finally, future research directions for neonatal use of Heliox are proposed.

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Heliox delivered by high flow nasal cannula improves oxygenation in infants with respiratory syncytial virus acute bronchiolitis

Cited by 15 publications

References 18 publications

Effects of heliox and non-invasive neurally adjusted ventilatory assist (NIV-NAVA) in preterm infants

Effects of heliox and non-invasive neurally adjusted ventilatory assist (NIV-NAVA) in preterm infants

Helium–oxygen in bronchiolitis—A systematic review and meta‐analysis

Neonatal Applications of Heliox: A Practical Review

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