Heliox for croup in children

Abstract

Background Croup is an acute viral respiratory infection with upper airway mucosal inflammation that may cause respiratory distress. Most cases are mild. Moderate to severe croup may require treatment with corticosteroids (from which benefits are o en delayed) and nebulised epinephrine (adrenaline) (which may be short-lived and can cause dose-related adverse e ects including tachycardia, arrhythmias, and hypertension). Rarely, croup results in respiratory failure necessitating emergency intubation and ventilation. A mixture of helium and oxygen (heliox) may prevent morbidity and mortality in ventilated neonates by reducing the viscosity of the inhaled air. It is currently used during emergency transport of children with severe croup. Anecdotal evidence suggests that it relieves respiratory distress. This review updates versions published in 2010 and 2013. Objectives To examine the e ect of heliox compared to oxygen or other active interventions, placebo, or no treatment, on relieving signs and symptoms in children with croup as determined by a croup score and rates of admission and intubation. Search methods We searched CENTRAL, which includes the Cochrane Acute Respiratory Infections Group's Specialised Register; MEDLINE; Embase; CINAHL; Web of Science; and LILACS in January and February 2018. We also searched the World Health Organization International Clinical Trials Registry Platform (apps.who.int/trialsearch/) and ClinicalTrials.gov (clinicaltrials.gov) on 8 February 2018. We contacted British Oxygen Company, a leading supplier of heliox (BOC Australia 2017). Selection criteria Randomised controlled trials (RCTs) and quasi-RCTs comparing the e ect of heliox in comparison with placebo or any active intervention(s) in children with croup. Heliox for croup in children (Review)

Noble gas neuroprotection: xenon and argon protect against hypoxic–ischaemic injury in rat hippocampus in vitro via distinct mechanisms

“…There has been interest in evaluating other less expensive noble gases as neuroprotectants that could be given in open circuits. Helium and oxygen mixtures have been used medically for respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD) in adults and bronchiolitis and croup in children, but systematic reviews conclude that the currently available evidence does not support its use in these conditions 64, 65, 66, 67. Our finding that helium has no effect on hypoxic–ischaemic injury in vitro is consistent with a lack of pharmacological effect of helium at normobaric pressures.…”

Application of aerosol therapy in respiratory diseases in children: A Saudi expert consensus

“…Further, its effect could be similar to 100% oxygen given with 1–2 doses of epinephrine. [ 188 ]…”

Update on current views and advances on RSV infection (Review)

“…Heliox and RSV-positive bronchiolitis. Since RSV-positive bronchiolitis is associated with airway obstruction and turbulent gas flow, its clinical course can be improved by Heliox, which facilitates gas flow through high-resistance airways (132)(133)(134)(135)(136)(137)(138). Heliox is a mixture of helium-oxygen, which can be administered by all modes of ventilation in spontaneously breathing patients by face mask, HFNc or CPAP, and can be adjusted to specific ventilators in intubated children.…”