A Multicenter Randomized Trial Assessing the Efficacy of Helium/Oxygen in Severe Exacerbations of Chronic Obstructive Pulmonary Disease

Jolliet, Philippe; Ouanes-Besbes, Lamia; Abroug, Fékri; Khelil, Jalila Ben; Besbes, Mohamed; Garnero, Aude; Arnal, Jean-Michel; Daviaud, Fabrice; Chiche, Jean‐Daniel; Lortat-Jacob, Benoît; Diehl, Jean‐Luc; Lerolle, Nicolas; Mercat, Alain; Razazi, Keyvan; Brun‐Buisson, Christian; Durand‐Zaleski, Isabelle; Texereau, J.; Brochard, Laurent

doi:10.1164/rccm.201601-0083oc

Cited by 40 publications

(31 citation statements)

References 18 publications

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“…For example, a Cochrane review (Rodrigo et al, 2002) concluded that current evidence is insufficient to support the use of HeO 2 mixtures in the treatment of acute exacerbations of COPD and future controlled trials are advocated. Recently, a large trial (16 intensive care units, 6 countries) found that HeO 2 improves respiratory acidosis, encephalopathy and respiratory rate more quickly than Air/O 2 for COPD patients but does not prevent NIV failure (Jolliet et al, 2016). In (Häussermann et al, 2015) healthy controls, moderate to severe asthmatic and COPD patients inhaled HeO 2 during exercise.…”

Section: Introductionmentioning

confidence: 99%

Calculated ventilation and effort distribution as a measure of respiratory disease and Heliox effectiveness

Pozin

Montesantos

Katz

et al. 2017

Journal of Biomechanics

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In spite of numerous clinical studies, there is no consensus on the benefit Heliox mixtures can bring to asthmatic patients in terms of work of breathing and ventilation distribution. In this article we use a 3D finite element mathematical model of the lung to study the impact of asthma on effort and ventilation distribution along with the effect of Heliox compared to air. Lung surface displacement fields extracted from computed tomography medical images are used to prescribe realistic boundary conditions to the model. Asthma is simulated by imposing bronchoconstrictions to some airways of the tracheo-bronchial tree based on statistical laws deduced from the literature. This study illuminates potential mechanisms for patient responsiveness to Heliox when affected by obstructive pulmonary diseases. Responsiveness appears to be function of the pathology severity, as well as its distal position in the tracheo-bronchial tree and geometrical position within the lung.

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Section: Introductionmentioning

confidence: 99%

Calculated ventilation and effort distribution as a measure of respiratory disease and Heliox effectiveness

Pozin

Montesantos

Katz

et al. 2017

Journal of Biomechanics

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“…Subsequently, international guidelines rightly recommended NIV as the first-line therapy for patients with AHRF 3,4. Several authors have carefully advised an escalation to endotracheal intubation in the case of persistent respiratory acidosis after a first NIV challenge 5–7. Others have recently tested extracorporeal CO 2 removal membrane after a first NIV trial that had failed to reverse hypercapnic acidosis 8,9.…”

Section: Introductionmentioning

confidence: 99%

Delayed but successful response to noninvasive ventilation in COPD patients with acute hypercapnic respiratory failure

Lemyze

Bury

Guiot

et al. 2017

COPD

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BackgroundWe evaluated a new noninvasive ventilation (NIV) protocol that allows the pursuit of NIV in the case of persistent severe respiratory acidosis despite a first NIV challenge in COPD patients with acute hypercapnic respiratory failure (AHRF).Patients and methodsA prospective observational multicentric pilot study was conducted in three tertiary hospitals over a 12-month study period. A total of 155 consecutive COPD patients who were admitted for AHRF and treated by NIV were enrolled. Delayed response to NIV was defined as a significant clinical improvement in the first 48 h following NIV initiation despite a persistent severe respiratory acidosis (pH <7.30) after the first 2 h of NIV trial.ResultsNIV failed in only 10 patients (6.5%). Delayed responders to NIV (n=83, 53%) exhibited similar nutritional status, comorbidities, functional status, frailty score, dyspnea score, and severity score at admission, compared with early responders (n=62, 40%). Only age (66 vs 70 years in early responders; P=0.03) and encephalopathy score (3 [2–4] vs 3 [2–4] in early responders; P=0.015) were different among the responders. Inhospital mortality did not differ between responders to NIV (n=10, 12% for delayed responders vs n=10, 16% for early responders, P=0.49). A second episode of AHRF occurred in 20 responders (14%), equally distributed among early and delayed responders to NIV (n=9, 14.5% in early responders vs n=11, 13% in delayed responders; P=0.83), with a poor survival rate (n=1, 5%).ConclusionMost of the COPD patients with AHRF have a successful outcome when NIV is pursued despite a persistent severe respiratory acidosis after the first NIV trial. The outcome of delayed responders is similar to the one of the early responders. On the contrary, the second episode of AHRF during the hospital stay carries a poor prognosis.

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“…[3][4][5][6] Most previous studies have examined the use of heliox in non-intubated subjects who were breathing spontaneously or with the support of noninvasive ventilation. [7][8][9][10][11] A review of studies involving subjects with acute asthma concluded that breathing heliox appeared to improve pulmonary function but had no effect on the rate of hospital admission. 7 Instead of simply breathing heliox, the latter can also be used to deliver bronchodilators by nebulization.…”

Section: Introductionmentioning

confidence: 99%

“…9 The use of heliox in subjects with exacerbations of COPD who required noninvasive ventilation has been evaluated in 2 large, multi-center randomized trials. 10,11 The first study found that heliox had no significant effect on arterial blood gases or the need for intubation. 10 In the second study, subjects who received heliox had a more rapid improvement in respiratory acidosis and encephalopathy, but their rates of intubation and mortality were no different from the rates of those who were treated with standard noninvasive ventilation.…”

Section: Introductionmentioning

confidence: 99%

“…10 In the second study, subjects who received heliox had a more rapid improvement in respiratory acidosis and encephalopathy, but their rates of intubation and mortality were no different from the rates of those who were treated with standard noninvasive ventilation. 11 Relatively few studies have examined the use of heliox during mechanical ventilation of subjects with severe airflow obstruction. [12][13][14][15][16] One study reported a reduction in peak airway pressure and P aCO 2 when heliox was given to ventilated subjects with asthma, but adjustment of ventilator settings during administration of heliox limits interpretation of the data.…”

Section: Introductionmentioning

confidence: 99%

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Lack of Benefit of Heliox During Mechanical Ventilation of Subjects With Severe Air-Flow Obstruction

2017

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BACKGROUND: The value of heliox (helium-oxygen mixture) for patients with severe air-flow obstruction is uncertain. The purpose of this study was to determine whether heliox could reduce the degree of hyperinflation and hypercapnia in mechanically ventilated patients with severe airflow obstruction. METHODS: This was a single-center, prospective observational study conducted in a medical ICU of an academic medical center. We assessed the impact of heliox (65-70% helium, 30 -35% oxygen) on airway pressures and arterial blood gases of 13 subjects undergoing mechanical ventilation for severe asthma (n ‫؍‬ 8) or exacerbation of COPD (n ‫؍‬ 5). RESULTS: As compared with ventilation with air-O 2 , heliox resulted in a reduction in peak airway pressure (54.1 ؎ 12.6 cm H 2 O vs 47.9 ؎ 10.8 cm H 2 O, P < .001) and P aCO 2 (64.3 ؎ 14.9 mm Hg vs 62.3 ؉ 15.1 mm Hg, P ‫؍‬ .01). In contrast, there was no change in plateau pressure (25.3 ؎ 5.5 cm H 2 O vs 25.8 ؎ 5.6 cm H 2 O, P ‫؍‬ .14) or total PEEP (13.4 ؎ 3.8 cm H 2 O vs 13.3 ؎ 4.1 cm H 2 O, P ‫؍‬ .79) in response to heliox. CONCLUSIONS: In mechanically ventilated subjects with severe air-flow obstruction, administration of heliox had no effect on indices of dynamic hyperinflation (plateau pressure and total PEEP) and resulted in only a small reduction in P aCO 2 .

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A Multicenter Randomized Trial Assessing the Efficacy of Helium/Oxygen in Severe Exacerbations of Chronic Obstructive Pulmonary Disease

Abstract: Heliox improves respiratory acidosis, encephalopathy, and the respiratory rate more quickly than air/O but does not prevent NIV failure. Overall, the rate of NIV failure was low. Clinical trial registered with www.clinicaltrials.gov (NCT 01155310).

Cited by 40 publications

References 18 publications

Calculated ventilation and effort distribution as a measure of respiratory disease and Heliox effectiveness

Calculated ventilation and effort distribution as a measure of respiratory disease and Heliox effectiveness

Delayed but successful response to noninvasive ventilation in COPD patients with acute hypercapnic respiratory failure

Lack of Benefit of Heliox During Mechanical Ventilation of Subjects With Severe Air-Flow Obstruction

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