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

Abstract

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.

Helium-oxygen mixture: clinical applicability in an intensive care unit

“…In our study, we chose to observe the cases of bronchospasm and wheezing, disorders in which Heliox ® improved gas exchange, decreased respiratory work, and prevented reintubation. ( 33 )…”

EBNEO commentary: Randomised controlled trial of heliox in newborn infants with meconium aspiration syndrome

“…It was postulated that this may be related to reduction of shear stress and barotrauma with heliox use and its effect on cell‐mediated immunity 7 . However, this effect was not replicated in subsequent studies 8 …”

Inhalation of Heliox as a potential treatment for the ARDS caused by COVID-19

“…This decreased turbulence remained evident even when air ow was restricted, as in the case of obstructive lung disease. Heliox has been applied to various respiratory diseases in adults for more than 70 years with no adverse effectswith no sereous complications reported [6].A case report showed that the combination of helium and oxygen is safe during pregnancy [7].…”