Avoiding Intubation in the Injured Subglottis: The Role of Heliox Therapy

Abstract

Intubation in the child presenting with severe viral tracheobronchitis or prior subglottic injury can be detrimental to the child and the subglottis. Intubation may lead to further mucosal ischemia, scar, subglottic stenosis, or failed extubation requiring a tracheotomy. Heliox is a combination of helium and oxygen that produces less-dense gas exchange. Its use leads to a decrease in turbulent airflow, which may obviate the need for intubation. Here we report our experience using heliox as initial therapy in 14 consecutive children presenting with severe airway distress and the need for intubation. (Five had viral tracheobronchitis, 5 had inflammatory exacerbation of subglottic stenosis, and 4 had acute iatrogenic subglottic injury.) In 10 of the 14 children, intubation, which can lead to mucosal injury and scarring, was avoided by the use of heliox therapy. Of the 4 children in whom heliox therapy failed, 3 had a prior history of subglottic stenosis. Heliox is a relatively safe and reliable alternative to intubation of children with severe subglottic edema or injury. Heliox should be considered before intubation for selected children with subglottic inflammation and severe airway distress.

Helmet‐delivered heliox‐CPAP in severe upper airway obstruction caused by PHACES syndrome

“…Heliox has been promoted as adjunctive therapy in pediatric severe upper airway obstruction 1, 11, 12. Due to its less density comparing to air or oxygen, it provides more laminar flow in obstructed airways.…”

Predictores de extubación fallida en el paciente pediátrico y neonatal

“…En poblaciones de niños más grandes Heliox ha mostrado resultados un poco más favorables como medida para prevenir la reintubación en pacientes con croup postextubación, aunque sigue siendo controvertido su verdadera utilidad (52). Otros ensayos resaltan más su ventaja si esta administración es antes de la intubación en pacientes con patologías con componente inflamatorio subglótico (53).…”

Current Applications of Therapeutic Gases in Neonatal Intensive Care

“…Several studies have reported effects such as the reduction of flow turbulence in the airways and air-trapping in the lungs, and improvement of the distal-airway deposition of aerosol particles [43][44][45][46]. Several physics laws may explain He properties and behavior, particularly the Reynolds' Number, calculated as flow x diameter x density / viscosity.…”