Resp Care
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For over 70 years, helium-oxygen mixture (heliox) has been promoted as adjunctive therapy to overcome airflow-obstructive disorders and lesions. In the past 2 decades heliox has gained widespread support in many pediatric emergency departments and intensive care units, in treatment of infants and children with both upper and lower airway obstruction. ⋯ Clinical evidence of the effectiveness of heliox in pediatric patients with airflow obstruction is relatively sparse and appears in the literature primarily as case presentations, case series, and small, uncontrolled studies. This article reviews the rationale and methods for heliox treatment of children with asthma, airway obstruction, bronchiolitis, and croup.
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Our understanding of albuterol nebulization driven by helium-oxygen mixture (heliox) has matured with recent advances in clinical therapy, delivery systems, and understanding of dosing; this has led to substantial improvements in delivery as well as refinements of research protocols for asthma exacerbations. This review begins with heliox inhalation therapy and then addresses heliox as a driving gas for nebulization. Technical considerations are reviewed, including optimal gas mixtures, flow-rate adjustment factors, and nebulizer setup.
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Helium-oxygen mixture (heliox) has been advocated for clinical use since 1934, and there has been a growing array of clinical applications. Until recently, administering heliox has required jury-rigging by modifications and/or extension of available devices not designed for use with heliox. This paper reviews devices required to administer heliox and considers how devices designed to deliver air and/or oxygen have been adapted for use with heliox. Use of devices outside of their design limits adds risk and liability, whereas using Food-and-Drug-Administration cleared devices for heliox administration reduces the risk and liability.
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Evidence-based respiratory therapy for exacerbations of chronic obstructive pulmonary disease (COPD) includes oxygen, inhaled bronchodilators, and noninvasive positive-pressure ventilation. Examining the physics of gas flow, a case can be made either for or against the use of helium-oxygen mixture (heliox) in the care of patients with COPD. The evidence for the use of heliox in patients with COPD exacerbation is not strong at present. ⋯ Moreover, the use of heliox is hampered by the lack of widespread availability of an approved heliox delivery system. Appropriately designed randomized controlled trials with patient-important outcomes, such as avoidance of intubation, decreased intensive-care-unit and hospital days, and decreased cost of therapy, are sorely needed to establish the role of heliox in patients with COPD exacerbation, including those receiving noninvasive positive-pressure ventilation. Lacking such evidence, the use of heliox in patients with COPD exacerbation cannot be considered standard therapy.