Use of Heliox in the Management of Neonates with Meconium Aspiration Syndrome

Abstract

Background: Helium-oxygen mixture (heliox) ventilation has been known as an alternative treatment in patients with airway obstruction. Because of the physical properties of heliox, mechanical ventilation with this gas mixture may offer advantages in the management of respiratory failure associated with meconium aspiration syndrome (MAS). Objectives: The purpose of this pilot study was to assess the effect of short-term mechanical ventilation with heliox in newborns with MAS on vital signs, oxygenation, acid-base balance and respiratory function parameters. Methods: The study was carried out in newborns with respiratory failure requiring mechanical ventilation due to MAS. Eight patients were ventilated using pressure-controlled synchronized intermittent mandatory ventilation. Parameters of respiratory function, oxygenation, acid-base balance and vital signs were recorded at baseline, then twice during 1 h of heliox ventilation and finally twice during 1 h after switching back to air-oxygen ventilation. Results: Mechanical ventilation with heliox did not affect vital signs and the infants’ clinical condition remained stable during the study. Heliox ventilation was associated with a nonsignificant increase in tidal volume, minute ventilation and peak expiratory flow rate values. Mechanical ventilation with heliox allowed the use of significantly lower FiO₂, with a significant decrease in alveolar-arterial oxygen tension difference and a decrease in the oxygenation index which was not statistically significant. There was also a significant increase in the PaO₂/FiO₂ ratio during heliox ventilation. Conclusions: Ventilation with a helium and oxygen mixture had a positive effect on the selected parameters of oxygenation, while its effects on other respiratory parameters were relatively small.

Effects of heliox and non-invasive neurally adjusted ventilatory assist (NIV-NAVA) in preterm infants

“…Conventional ventilation with heliox (helium and oxygen mixture) was found to reduce work of breathing, improve oxygenation and CO 2 elimination, as well as enhance the distribution of gas within the respiratory system 2 . Findings from previous studies on heliox application in newborns during mechanical ventilation are encouraging 5 – 7 . However, knowledge about the physiological effects of this gas mixture during the non-invasive ventilation (NIV) in premature infants is limited.…”

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

“…In a pilot study in 8 newborns who were mechanically ventilated in a pressure-controlled SIMV mode because of respiratory failure due to meconium aspiration, 80% heliox was administered for 1 h [38]. There was a trend towards increased expiratory tidal volumes, minute ventilation and a peak expiratory flow rate during heliox ventilation.…”

The roles of drug therapy given via the endotracheal tube to neonates

“…In another study, heliox administration in 10 infants who were studied before extubation was associated with a reduction in their work of breathing 50. A pilot study of eight ventilated neonates with meconium aspiration syndrome demonstrated that mechanical ventilation when heliox was administered was associated with a significantly lower fraction of inspired oxygen concentration and alveolar-arterial oxygen tension difference 51. Randomised trials are required to more robustly determine the efficacy of this therapy.…”