• Salvatore Maurizio Maggiore, Jean-Christophe M Richard, Fekri Abroug, Jean Luc Diehl, Massimo Antonelli, Philippe Sauder, Jordi Mancebo, Miquel Ferrer, Francois Lellouche, Laurent Lecourt, Gaetan Beduneau, and Laurent Brochard.
• Department of Anesthesiology and Intensive Care, Agostino Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy.
• Crit. Care Med. 2010 Jan 1;38(1):145-51.

ObjectiveTo assess the effect of a helium-oxygen mixture on intubation rate and clinical outcomes during noninvasive ventilation in acute exacerbation of chronic obstructive pulmonary disease.DesignMulticenter, prospective, randomized, controlled trial.SettingSeven intensive care units.PatientsA total of 204 patients with known or suspected chronic obstructive pulmonary disease and acute dyspnea, Paco2> 45 mm Hg and two among the following factors: pH <7.35, Paco2 <50 mm Hg, respiratory rate >25/min.InterventionsNoninvasive ventilation randomly applied with or without helium (inspired oxygen fraction 0.35) via a face mask.Measurements And Main ResultsDuration and complications of NIV and mechanical ventilation, endotracheal intubation, discharge from intensive care unit and hospital, mortality at day 28, adverse and serious adverse events were recorded. Follow-up lasted until 28 days since enrollment. Intubation rate did not significantly differ between groups (24.5% vs. 30.4% with or without helium, p = .35). No difference was observed in terms of improvement of arterial blood gases, dyspnea, and respiratory rate between groups. Duration of noninvasive ventilation, length of stay, 28-day mortality, complications and adverse events were similar, although serious adverse events tended to be lower with helium (10.8% vs. 19.6%, p = .08).ConclusionsDespite small trends favoring helium, this study did not show a statistical superiority of using helium during NIV to decrease the intubation rate in acute exacerbation of chronic obstructive pulmonary disease.

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