Heliox versus oxygen for nebulized aerosol therapy in children with lower airway obstruction

Abstract

Related to its physical properties, heliox gas seems to have a strong and pronounced effect when used in patients with severe lower airway obstruction. However, in the absence of severe lower airway obstruction, there is no advantage to using heliox instead of oxygen as a vehicle of nebulization.

Noninvasive Therapy with Helium–Oxygen for Severe Bronchiolitis

“…22 Evidence of any beneficial effect on lower airway obstruction is much less substantiated. 23,24 Bronchiolitis is characterized by inflammation of the bronchioles, which leads to desquamation of necrotized airway epithelium, increased secretions, and submucosal edema. 25 All of these factors result in obstruction of the small airways, which causes the respiratory distress typically seen and involves turbulent rather than laminar flow in the airways.…”

The Science Guiding Selection of an Aerosol Delivery Device

“…In obstructive airways disease the opportunity to decrease turbulent air flow through obstructive airways with a less dense gas offers the hypothetical advantage of delivering aerosol particles and medications distal to the obstructions. [15][16][17][18] Heliox is a gas mixture of helium (60 -80%) and oxygen, which is used to improve air flow in patients with partial airway obstruction. 19 Clinical studies utilizing heliox as the driving gas for delivery of aerosolized asthma medications in asthmatics have reported conflicting results, 20 which makes evidencebased decisions on its use undeterminable for several possible reasons.…”

Development of Aerosol Drug Delivery with Helium Oxygen Gas Mixtures

“…Piva et al reported a similar result. 35 Hess et al reported that both aerosol size and the amount of drug mass (albuterol) in respirable sizes decreased when 80/20 heliox was utilized compared to air at the same flowrate. 36 The difference in these studies is likely a consequence of the aerosol sizing methods used, that is, a drug concentration method for measuring size (Hess) versus an optical method that measures literal geometric size (Corcoran, Piva), and may be indicative of a drug concentrating effect.…”

“…The study was performed at set inhalation flow rates limiting the ability to predict deposition effects in the upper airways during an uncontrolled inhalation with heliox. In a double-blinded randomized study, Piva et al 35 administered radioisotope aerosols via nebulizer to 20 children with lower airway obstructions using either 80/20 heliox or oxygen. Overall, the subjects who utilized heliox deposited the aerosols at a higher rate in the lungs.…”