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

Neumann-Klimasińska, Natalia; Merritt, T. Allen; Beck, Jennifer; Miechowicz, Izabela; Szymankiewicz-Bręborowicz, Marta; Szczapa, Tomasz

doi:10.1038/s41598-021-95444-2

Cited by 4 publications

(8 citation statements)

References 26 publications

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“…Unfortunately, as quick as the respiratory effects of this mixture appear after start of delivery, it will also be noted that after discontinuation they will quickly cease after helium-oxygen is stopped. This phenomenon was observed in several studies in neonates ( 6 , 15 , 17 ). Hence, some authors proposed to consider Heliox as “therapeutic bridge” that allows enhanced support until the primary cause of respiratory failure resolves.…”

Section: Practical Issuessupporting

confidence: 67%

“…Heliox ventilation was reported to reduce respiratory effort, diaphragmatic load and display protective effects against atelectasis and airway collapse. In addition, it facilitates the distribution of respiratory gases in narrow and/or constricted airways ( 17 , 23 – 25 ). Helium-oxygen may allow better penetration into the peripheral parts of the lungs and improve ventilation/perfusion ratio.…”

Section: Physiological Effects Of Helioxmentioning

confidence: 99%

“…In a study carried out in preterm infants the electrical activity of the diaphragm (EDI) was compared during air-oxygen and heliox non-invasive respiratory support. It has been shown that EDI decreased significantly after heliox ventilation was started ( 17 ).…”

Section: Physiological Effects Of Helioxmentioning

confidence: 99%

“…It was found that Heliox NIV-NAVA was associated with a prompt and significant reduction of Edi indicating reduced respiratory effort. Decreased respiratory rate and peak inspiratory pressure were also observed ( 17 ).…”

Section: Clinical Applications Of Helioxmentioning

confidence: 99%

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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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Section: Practical Issuessupporting

confidence: 67%

Section: Physiological Effects Of Helioxmentioning

confidence: 99%

Section: Physiological Effects Of Helioxmentioning

confidence: 99%

Section: Clinical Applications Of Helioxmentioning

confidence: 99%

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Neonatal Applications of Heliox: A Practical Review

2022

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“…Prospects for the future include determining the metabolomic profile of blood, urine, or exhaled air ( 23 ). All of these factors can hasten the SF decision or encourage early measures unrelated to SF that reduce the risk of MV, such as increasing end-expiratory pressure, switching from nCPAP to NIPPV, or considering special therapies that improve the efficacy of respiratory support, such as heliox ( 23 – 26 ).…”

Section: Discussionmentioning

confidence: 99%

FiO2 Before Surfactant, but Not Time to Surfactant, Affects Outcomes in Infants With Respiratory Distress Syndrome

Kruczek¹,

Krajewski²,

Hożejowski³

et al. 2021

Front. Pediatr.

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Aim: To establish the impact of oxygen requirement before surfactant (SF) and time from birth to SF administration on treatment outcomes in neonatal respiratory distress syndrome (RDS).Methods: We conducted a post-hoc analysis of data from a prospective cohort study of 500 premature infants treated with less invasive surfactant administration (LISA). LISA failure was defined as the need for early (<72 h of life) mechanical ventilation (MV). Baseline clinical characteristic parameters, time to SF, and fraction of inspired oxygen (FiO2) prior to SF were all included in the multifactorial logistic regression model that explained LISA failure.Results: LISA failed in 114 of 500 infants (22.8%). The median time to SF was 2.1 h (IQR: 0.8–6.7), and the median FiO2 prior to SF was 0.40 (IQR: 0.35–0.50). Factors significantly associated with LISA failure were FiO2 prior to SF (OR 1.03, 95% CI 1.01–1.04) and gestational age (OR 0.82, 95 CI 0.75–0.89); both p <0.001. Time to SF was not an independent risk factor for therapy failure (p = 0.528) or the need for MV at any time during hospitalization (p = 0.933).Conclusions: The FiO2 before SF, but not time to SF, influences the need for MV in infants with RDS. While our findings support the relevance of FiO2 in SF prescription, better adherence to the recommended FiO2 threshold for SF (0.30) is required in daily practice.

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