Heliox for Pediatric Critical Asthma: A Multicenter, Retrospective, Registry-Based Descriptive Study

Abstract

Background: In cases of critical asthma (CA), heliox may be applied as an adjunctive rescue therapy to avoid invasive mechanical ventilation (MV), improve deposition of aerosolized medications, and enhance laminar airflow through obstructed airways. Using the Pediatric Health Information System (PHIS) registry, we evaluate heliox prescribing and explored for differences in MV rates and hospital length of stay (LOS) among children with and without heliox exposure. Methods: We performed a retrospective cohort study using PHIS data from 42 pediatric intensive care units among children 5-17 years of age admitted for CA from 2010 through 2019. Primary outcomes were heliox prescribing rates and trends. Secondary outcomes were invasive MV rates and LOS assessed in a subgroup of children receiving ≥ 1 adjunctive intervention(s). Results: Of the 19,780 studied, heliox was prescribed in 12.5% and linearly declined from 16.1% in 2010 to 5.6% in 2019. The overall MV rate was 12.8% and was lower in subjects receiving heliox alone (4.9%) compared to heliox plus alternative adjunctive therapies [31.2%] or children receiving non-heliox adjunctive therapies [22.1%], P < .01). Accounting for MV, no difference in LOS was observed. In exploratory adjusted models, MV free hospitalization was associated with heliox-only exposure (OR: 0.33, 95% CI: 0.17-0.63, P < .01) and exposure to multiple adjunctive therapies was associated with MV (OR: 2.48, 95% CI: 1.56-3.94, P < .01). Conclusions: In this multicenter retrospective study from 42 children’s hospitals, heliox prescribing for CA declined over the last decade. Subjects receiving multiple adjunctive therapies more commonly required invasive MV perhaps indicating a greater severity of illness. At this time, prospective trials needed to identify the role of heliox for pediatric CA.

Wide Institutional Variability in the Treatment of Pediatric Critical Asthma: A Multicenter Retrospective Study

“…It is an observational study using a large, administrative database. Although the possibility for data entry and processing errors exists, data that are stored in the PHIS database undergo several quality checks before assimilation into the database and it has supported several studies of pediatric asthma (6, 35, 36). This study is observational in nature and subject to several potential biases, and any observed relationships are only associations, not causal.…”

Efficacy and Safety of Prolonged Magnesium Sulfate Infusions in Children With Refractory Status Asthmaticus

“…In our study, we found a higher number of patients in the treatment group received an additional advanced therapy. Several previous studies have assessed outcomes in children receiving these advanced therapies ( 22 , 30 , 31 ). However, these authors only assessed outcomes of patients receiving one advanced therapy whereas we evaluated outcomes of children receiving more than one advanced therapy ( 22 , 30 , 31 ).…”

“…Several previous studies have assessed outcomes in children receiving these advanced therapies ( 22 , 30 , 31 ). However, these authors only assessed outcomes of patients receiving one advanced therapy whereas we evaluated outcomes of children receiving more than one advanced therapy ( 22 , 30 , 31 ). One recent study by Stulce et al evaluated outcomes in 1,144 children with status asthmaticus, in the Pediatric Health Information System database from 2016 to 2019, that received terbutaline and aminophylline as a second-tier therapy ( 29 ).…”

Efficacy of using helium-oxygen mixture in the intensive care of pneumonia in adult patients: a systematic review and meta-analysis

“…Чаще всего гелий используется для снижения работы дыхания во время обострений бронхиальной астмы, хронической обструктивной болезни легких (ХОБЛ) [7][8][9][10]. В литературе большая часть данных о действии КГС была собрана в этих группах пациентов.…”