Heliox Adjunct Therapy for Neonates With Congenital Diaphragmatic Hernia

Wise, Audra; Boutin, Mallory A.; Knodel, Ellen; Proudfoot, James; Lane, Brian; Evans, Marva L.; Suttner, Denise; Kimball, Amy

doi:10.4187/respcare.06079

Cited by 7 publications

(7 citation statements)

References 30 publications

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“…Utilising heliox as an adjunctive therapy to the ventilation of infants with CDH was shown in one retrospective cohort study to be beneficial in reducing levels of hypercapnia (68 vs. 49 mmHg; p < 0.001) and levels of maximal ventilatory support required from high frequency oscillatory ventilation, and thus may be one such therapy to improve gas exchange in those with lung hypoplasia (57). Prospective randomised trials are required to ascertain the benefit of such therapy on short-and long-term pulmonary outcomes.…”

Section: Heliox Therapymentioning

confidence: 99%

Respiratory Support of Infants With Congenital Diaphragmatic Hernia

Williams

Greenough

2021

Front. Pediatr.

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Optimisation of respiratory support of infants with congenital diaphragmatic hernia (CDH) is critical. Infants with CDH often have severe lung hypoplasia and abnormal development of their pulmonary vasculature, leading to ventilation perfusion mismatch. It is vital that lung protective ventilation strategies are employed during both initial stabilisation and post-surgical repair to avoid ventilator induced lung damage and oxygen toxicity to prevent further impairment to an already diminished gas-exchanging environment. There is a lack of robust evidence for the routine use of surfactant therapy during initial resuscitation of infants with CDH and thus administration cannot be recommended outside clinical trials. Additionally, inhaled nitric oxide has been shown to have no benefit in reducing the mortality rates of infants with CDH. Other therapeutic agents which beneficially act on pulmonary hypertension are currently being assessed in infants with CDH in randomised multicentre trials. The role of novel ventilatory modalities such as closed loop automated oxygen control, liquid ventilation and heliox therapy may offer promise for infants with CDH, but the benefits need to be determined in appropriately designed clinical trials.

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Section: Heliox Therapymentioning

confidence: 99%

Respiratory Support of Infants With Congenital Diaphragmatic Hernia

Williams

Greenough

2021

Front. Pediatr.

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“…Chest X-ray after 5 h of Heliox MV revealed decreased air-trapping; significant improvement of oxygenation was also observed ( 14 ). Concurrent use of Heliox and iNO was also reported in infants with congenital diaphragmatic hernia ( 32 ).…”

Section: Clinical Applications Of Helioxmentioning

confidence: 90%

“…Analysis of available data suggests that in infants Heliox should be administered with positive pressure in order to observe its beneficial effects. Its application was combined with HFNC, nCPAP, NIPPV, NIV-NAVA and in the intubated neonates ( 11 , 14 , 32 , 54 ). Conventional ventilation with Heliox requires a variable orifice proximal flow sensor as standard hot-wire sensors will not provide reliable measurements ( Figure 4 ).…”

Section: Practical Issuesmentioning

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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“…Originally, HFOV is a ventilatory method that uses a high lung expansion pressure and tidal volume below the anatomical dead space to maintain lung oxygenation (open lung approach) and to decrease ventilator-induced lung injury. Therefore, the main indications for HFOV would be diseases presenting with low lung compliance and hypoxia such as pneumonia, adult respiratory distress syndrome, and congenital diaphragmatic hernias (7). Contrastingly, diseases with increased airway resistance-such as bronchial asthma, bronchiolitis or tracheal stenosis-are more problematic since they result in signi cant hypercapnia compared with hypoxemia.…”

Section: Discussionmentioning

confidence: 99%

“…Helium-oxygen gas mixtures have been used in several clinical scenarios, such as bronchiolitis and other forms of distal airway obstruction, as it is known to signi cantly decreasing airway resistance and ease breathing(6). In addition, a recent retrospective cohort study showed that a helium-oxygen gas mixture improved CO 2 washout in conventional mechanical ventilation (CMV) and decreased settings of ventilator in neonates with congenital diaphragmatic hernias (7).…”

Section: Introductionmentioning

confidence: 99%

Helium administration is more effective during piston-driven high-frequency oscillatory ventilation than conventional mechanical ventilation in a rabbit model

Akiyama

Tatsunami

Akita

et al. 2022

Preprint

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Background Low-molecular-weight gases such as helium are more likely to form laminar flows. Using helium-oxygen mixtures instead of nitrogen-oxygen mixtures during mechanical ventilation has been shown to accelerate carbon dioxide (CO2) excretion. Helium-oxygen mixtures have been used with mechanical ventilator settings such as high-frequency oscillatory ventilation (HFOV) and conventional mechanical ventilation (CMV). However, to the best of our knowledge, studies have not been conducted to determine the optimal ventilator setting for the promotion of CO2 excretion when helium is administered. This study aimed to compare the efficacy of using helium-oxygen gas mixtures between pressure-controlled CMV and piston-driven HFOV in rabbit models. CO2 transition was evaluated using blood gas analysis performed during and after helium administration. Experimental data were analyzed using parametric statistical methods. A repeated measures analysis of variance was used to compare CO2 excretion between HFOV and CMV. Results There was no statistically significant difference in the partial pressure of CO2 (PaCO2) or oxygen (PaO2) values before or after helium administration. Compared with pre-helium administration, PaCO2 values during helium administration were decreased under both CMV and piston-driven HFOV. Moreover, the PaCO2 transition during helium administration while using piston-driven HFOV was shown to be statistically significantly different (P < 0.001). Conclusions This study demonstrated that helium enhances CO2 elimination more significantly during piston-driven HFOV compared with that in CMV in rabbit models with normal lungs. With further study and clinical trials, these results imply that the use of HFOV while using a helium-oxygen mixture may improve CO2 excretion.

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Heliox Adjunct Therapy for Neonates With Congenital Diaphragmatic Hernia

Cited by 7 publications

References 30 publications

Respiratory Support of Infants With Congenital Diaphragmatic Hernia

Respiratory Support of Infants With Congenital Diaphragmatic Hernia

Neonatal Applications of Heliox: A Practical Review

Helium administration is more effective during piston-driven high-frequency oscillatory ventilation than conventional mechanical ventilation in a rabbit model

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