Helium-oxygen therapy for pediatric acute severe asthma requiring mechanical ventilation

Abd-Allah, Shamel; Rogers, Mark S; Terry, Michael H.; Gross, Matthew; Perkin, Ronald M.

doi:10.1097/01.pcc.0000074267.11280.78

Cited by 39 publications

(15 citation statements)

References 29 publications

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“…Additional studies have reported similar results of reduced peak inspiratory pressures and improved gas exchange, 117 as well as reduced intrinsic PEEP and work of breathing 112 when heliox mixtures are used during mechanical ventilation.…”

Section: Helioxsupporting

confidence: 52%

Adjunct Therapies During Mechanical Ventilation: Airway Clearance Techniques, Therapeutic Aerosols, and GasesDiscussion

Kallet

2013

Respir Care

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Mechanically ventilated patients in respiratory failure often require adjunct therapies to address special needs such as inhaled drug delivery to alleviate airway obstruction, treat pulmonary infection, or stabilize gas exchange, or therapies that enhance pulmonary hygiene. These therapies generally are supportive in nature rather than curative. Currently, most lack high-level evidence supporting their routine use. This overview describes the rationale and examines the evidence supporting adjunctive therapies during mechanical ventilation. Both mechanistic and clinical research suggests that intrapulmonary percussive ventilation may enhance pulmonary secretion mobilization and might reverse atelectasis. However, its impact on outcomes such ICU stay is uncertain. The most crucial issue is whether aerosolized antibiotics should be used to treat ventilatorassociated pneumonia, particularly when caused by multi-drug resistant pathogens. There is encouraging evidence from several studies supporting its use, at least in individual cases of pneumonia non-responsive to systemic antibiotic therapy. Inhaled pulmonary vasodilators provide at least short-term improvement in oxygenation and may be useful in stabilizing pulmonary gas exchange in complex management situations. Small uncontrolled studies suggest aerosolized heparin with N-acetylcysteine might break down pulmonary casts and relieve airway obstruction in patients with severe inhalation injury. Similar low-level evidence suggests that heliox is effective in reducing airway pressure and improving ventilation in various forms of lower airway obstruction. These therapies generally are supportive and may facilitate patient management. However, because they have not been shown to improve patient outcomes, it behooves clinicians to use these therapies parsimoniously and to monitor their effectiveness carefully. Key words: high-frequency percussive ventilation; intrapulmonary percussive ventilation; inhaled nitric oxide; aerosolized prostacyclin; aerosolized heparin; metered-dose inhalers; heliox.

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Section: Helioxsupporting

confidence: 52%

Adjunct Therapies During Mechanical Ventilation: Airway Clearance Techniques, Therapeutic Aerosols, and GasesDiscussion

Kallet

2013

Respir Care

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“…Heliox reduces peak airway pressures when used in patients who require mechanical ventilation, presumably by allowing hyperinflated alveoli to decompress during expiration and reducing the functional residual capacity of patients with asthma. 150 The existing evidence does not provide support for the routine use of helium-oxygen mixtures to all ED patients with acute asthma. However, new evidence suggests certain beneficial effects in patients with more severe airway obstruction.…”

Section: Helium-oxygen Mixture (Heliox)mentioning

confidence: 99%

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Nievas

Anand

2013

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES An increasing prevalence of pediatric asthma has led to increasing burdens of critical illness in children with severe acute asthma exacerbations, often leading to respiratory distress, progressive hypoxia, and respiratory failure. We review the definitions, epidemiology, pathophysiology, and clinical manifestations of severe acute asthma, with a view to developing an evidence-based, stepwise approach for escalating therapy in these patients. METHODS Subject headings related to asthma, status asthmaticus, critical asthma, and drug therapy were used in a MEDLINE search , supplemented by a manual search of personal files, references cited in the reviewed articles, and treatment algorithms developed within Le Bonheur Children's Hospital. RESULTS Patients with asthma require continuous monitoring of their cardiorespiratory status via noninvasive or invasive devices, with serial clinical examinations, objective scoring of asthma severity (using an objective pediatric asthma score), and appropriate diagnostic tests. All patients are treated with β-agonists, ipratropium, and steroids (intravenous preferable over oral preparations). Patients with worsening clinical status should be progressively treated with continuous β-agonists, intravenous magnesium, helium-oxygen mixtures, intravenous terbutaline and/or aminophylline, coupled with high-flow oxygen and non-invasive ventilation to limit the work of breathing, hypoxemia, and possibly hypercarbia. Sedation with low-dose ketamine (with or without benzodiazepines) infusions may allow better toleration of non-invasive ventilation and may also prepare the patient for tracheal intubation and mechanical ventilation, if indicated by a worsening clinical status. CONCLUSIONS Severe asthma can be a devastating illness in children, but most patients can be managed by using serial objective assessments and the stepwise clinical approach outlined herein. Following multidisciplinary education and training, this approach was successfully implemented in a tertiary-care, metropolitan children's hospital. INDEX TERMS asthma, child, critical care, infant, respiratory failure, status asthmaticus J Pediatr Pharmacol Ther 2013;18(2):88-104

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“…Heliox was not administered during mechanical ventilation. Although heliox has been demonstrated to provide benefit during mechanical ventilation in life-threatening pediatric status asthmaticus, the improvement in inflation pressure and PaCO 2 , while statistically significant, was clinically only modest (5). Furthermore, differences in gas characteristics between heliox and airnitrogen mixtures can result in inaccurate measurements of ventilatory variables (6).…”

Section: Medical Managementmentioning

confidence: 96%

Near-fatal pediatric asthma managed with pumpless arteriovenous carbon dioxide removal*

Conrad

Green²,

Scott³

2007

Critical Care Medicine

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Helium-oxygen therapy for pediatric acute severe asthma requiring mechanical ventilation

Abstract: In the pediatric patient with severe asthma requiring conventional mechanical ventilation, helium-oxygen administration appears to be a safe therapy and may assist in lowering peak inspiratory pressure and improving blood gas pH and partial pressure CO(2).

Cited by 39 publications

References 29 publications

Adjunct Therapies During Mechanical Ventilation: Airway Clearance Techniques, Therapeutic Aerosols, and GasesDiscussion

Adjunct Therapies During Mechanical Ventilation: Airway Clearance Techniques, Therapeutic Aerosols, and GasesDiscussion

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Near-fatal pediatric asthma managed with pumpless arteriovenous carbon dioxide removal*

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