Inhaled Medical Gases: More to Breathe Than Oxygen

Gentile, Michael A.

doi:10.4187/respcare.01442

Cited by 32 publications

(27 citation statements)

References 102 publications

(97 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…119 Heliox also increases aerosol deposition in the lung periphery and therefore may improve the effectiveness of bronchodilator therapy. 115 This has been supported indirectly by studies reporting improved pulmonary function and lower dyspnea scores when bronchodilator therapy with jet nebulizers are powered by heliox. 112 When clinically acceptable gas exchange can be achieved with a reasonable degree of lung-protection, the costs associated with heliox do not justify its routine use during mechanical ventilation for patients with obstructive lung disease unless there exists profound air-trapping in the presence of hypotension and severe acidosis.…”

Section: Helioxmentioning

confidence: 96%

“…113 The primary mechanism by which heliox works is the fact that helium is 86% less dense than air (0.179 vs 1.293 g/L, respectively), which reduces turbulence, thus decreasing airways resistance and work of breathing. 115 Turbulence is characteristic of gas flow in the first 10 generations of human airways because of their branching architecture. 112 Compared to air/O 2 gas mixtures, helium/O 2 mixtures have only marginally increased viscosity, but substantially lower density.…”

Section: Helioxmentioning

confidence: 99%

See 1 more Smart Citation

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

Kallet

2013

Respir Care

View full text Add to dashboard Cite

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.

show abstract

Section: Helioxmentioning

confidence: 96%

Section: Helioxmentioning

confidence: 99%

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

Kallet

2013

Respir Care

View full text Add to dashboard Cite

show abstract

“…Mike Gentile provided an overview of several of the available medical gases-beyond oxygen. 29 Complementing Fineman's discussion, this presentation began with an overview of INO. Gentile noted that this topic is still actively discussed and studied, despite the availability of over 100,000 papers on nitric oxide and over 4,000 publications specifically focused on INO.…”

Section: Inhaled Medical Gases: More To Breathe Than Oxygenmentioning

confidence: 99%

Neonatal and Pediatric Respiratory Care: What Does the Future Hold?

DiBlasi

Cheifetz

2011

Respir Care

View full text Add to dashboard Cite

Neonatal and pediatric respiratory care continues to move forward at a truly impressive pace. Recent technologic advances and an increasing number of randomized clinical trials are leading to improved outcomes for neonates, infants, children, and adolescents with respiratory illness. The goals of this 47th RESPIRATORY CARE Journal Conference were to review pertinent recent advances in neonatal and pediatric respiratory care and, more importantly, to offer thoughts and perspectives for the future of our field. It is important to note that of the prior 46 Journal Conferences, only 2 have been dedicated to neonatal and/or pediatric respiratory care topics. It is our hope that the publication of these proceedings will provide respiratory therapists, physicians, and other members of the clinical care team a foundation on which to ponder the future of neonatal and pediatric respiratory care.

show abstract

“…Another potential benefit of helium is that it may have anti-inflammatory properties [20]. Helium has been used to reduce the work of breathing during exacerbations of asthma and COPD [19,21,22,23]. Most of the data on the effect of heliox have been gathered within these patient populations, whilst most asthma studies have been conducted in the paediatric population.…”

Section: Introductionmentioning

confidence: 99%

“…As a result, during heliox ventilation, lower driving pressures are necessary to distribute oxygen to the distal alveoli to improve oxygenation [18,19]. Also, diffusion capacities of CO 2 are increased, further resulting in improved gas exchange [18].…”

Section: Introductionmentioning

confidence: 99%

The Potential of Heliox as a Therapy for Acute Respiratory Distress Syndrome in Adults and Children: A Descriptive Review

et al. 2015

View full text Add to dashboard Cite

Background: In neonatal respiratory distress syndrome (RDS) and acute RDS (ARDS) mechanical ventilation is often necessary to manage hypoxia, whilst protecting the lungs through lower volume ventilation and permissive hypercapnia. Mechanical ventilation can, however, induce or aggravate the lung injury caused by the respiratory distress. Helium, in a gas mixture with oxygen (heliox), has a low density and can reduce the flow in narrow airways and allow for lower driving pressures. Objectives: The aim of this study was to review preclinical and clinical studies of the use of heliox ventilation in acute lung injury associated with respiratory failure. Methods: A systematic search was executed in the PubMed and EMBASE databases, with search terms referring to ARDS or an acute lung injury condition associated with respiratory failure and the corresponding intervention. Results: A total of 576 papers were retrieved. After the majority had been excluded 20 papers remained, of which 6 articles described animal models (3 paediatric; 3 adult animal models) and 14 were clinical studies, of which 12 described paediatric patient populations and 2 adult patient populations. In both paediatric and adult animal models, heliox improved gas exchange while allowing for less invasive ventilation in a wide variety of models using different ventilation modes. Clinical studies show a reduction in the work of breathing during heliox ventilation, with a concomitant increase in pH and decrease in PaCO₂ levels compared to oxygen ventilation. Conclusions: Although evidence so far is limited, there may be a rationale for heliox ventilation in ARDS as an intervention to improve ventilation and reduce the work of breathing.

show abstract

Inhaled Medical Gases: More to Breathe Than Oxygen

Cited by 32 publications

References 102 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

Neonatal and Pediatric Respiratory Care: What Does the Future Hold?

The Potential of Heliox as a Therapy for Acute Respiratory Distress Syndrome in Adults and Children: A Descriptive Review

Contact Info

Product

Resources

About