Administration And Technical Information
To use Heliox does not require the introduction of any additional equipment beyond that which is available in most emergency departments as standard. Commercial mixtures are available in portable cylinders containing 1200 litres of gas, which is ideal for storage and transport within the emergency department. Standard cylinders contain Heliox in a mixture of 79% helium and 21% oxygen, though nasal cannulas can be used to provide additional oxygen to the patient receiving Heliox where there is a risk of hypoxia. However, as the oxygen concentration increases, the gas mixture becomes denser and its clinical effectiveness is reduced. Administration is best via a non-rebreathing facemask as this allows the best concentration to be delivered to the patient without any mixing of room air to occur. Heliox cylinders cost about four times as much as an equal volume of oxygen and this has no doubt contributed to some of the reluctance to its use and to carrying out large scale randomised controlled trials. This cost however, must be balanced against potential for reduction in morbidity and mortality associated with various airway disorders and specifically the cost associated with intubation and mechanical ventilation.
Heliox Compared To Either Oxygen Or Air For People With Acute Asthma
Acute asthma is a common disease presentation to the emergency department in many countries. Treatment of acute asthma is based on rapid reversal of bronchospasm and arresting airway inflammation. The main agents employed to treat acute asthma include combined treatments with bronchodilating agents and corticosteroids. However, there is evidence that helium and oxygen mixtures may provide additional benefits to patients with acute asthma. This review examines the evidence from tenrandomised controlled trials involving 544 patients which compared heliox to oxygen or air, when used in conjunction with the other standard acute treatments. The reviewers conclude that the evidence does not support routine use of heliox in patients with acute asthma.
The existing evidence does not provide support for the administration of helium-oxygen mixtures to all ED patients with acute asthma. At this time, heliox treatment does not have a role to play in the initial treatment of patients with acute asthma. Nevertheless, new evidence suggests certain beneficial effects in patients with more severe obstruction. Since these conclusions are based upon between-group comparisons and small studies, they should be interpreted with caution.
To determine the effect of the addition of heliox to standard medical care on the course of acute asthma, as measured by pulmonary function testing and clinical endpoints.
Physical Properties Of Helium To Apply For Respiratory Care
Heliox is a low density gas mixture of helium and oxygen commonly used in deep diving, and also for clinical purposes, particularly in the critical care setting. Heliox breathing reduces air flow resistance within the bronchial tree in patients with obstructive lung disease, and has beneficial effects in severe asthma attacks. Heliox may also reduce the work of breathing and improve pulmonary gas exchange efficiency. Despite the encouraging results, heliox use in routine practice remains controversial because of technical implications and high costs. Lower density of heliox compared with the air or oxygen regardless of the concentration of helium in the mixture improves air flow through constricted ways by transforming turbulent flow into laminar flow. Benefits are seen quickly, usually within an hour of initiation of treatment.
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Heliox For The Difficult Airway
Heliox Setup in the OR at the University of Iowa
Heliox for the difficult airway
Heliox has a lower density than air or oxygen regardless of the concentration of helium in the mixture. It improves airflow through constricted passages. Disadvantages include expense, special equipment and training.
It has been reported that for heliox administration to be effective, the helium concentration “must ideally be > 60%, and gas flows must meet or exceed the inspiratory flow demands of the patient so that heliox concentration is not diluted with room air”
Research has focused on pediatric populations with both upper and lower airway obstruction with the focus on case series –
Morgan S, Vukin K, Mosakawoski S, Solano P, Stanton L, Lester L, Lavani R, hall JB and tung A: Use of Heliox Delivered via High-Flow Nasal Cannual to Treat an Infant with Coronavirsu-Related Respiratory Infection and Severe Acute Air-flow Obstruction” Respir Care 2014 59 :e166-1170
Kass JE, Castriotta RJ. Heliox therapy in acute severe asthma. Chest 1995 107:75760.
Gluck EH, Onorato DJ, Castriotta R. Helium-oxygen mixtures in intubated patients with status asthmaticus and respiratory acidosis. Chest 1990 98:6938.
Khanlou H, Eiger G. Safety and efficacy of heliox as a treatment for upper airway obstruction due to radiation-inducedlaryngeal dysfunction.Heart Lung2001 30:1467.
What Is Heliox Therapy
Heliox therapy is a medical treatment using a mixture of helium and oxygen gases to alleviate symptoms of various types of respiratory distress that has been available to medical science since 1934. These treatments are for conditions like asthma, bronchiolitis, and chronic obstructive pulmonary disease . Helium has replaced nitrogen, which was used in earlier attempts as a carrier gas, because it is less dense than nitrogen and enables easier breathing and the absorption of oxygen into the bloodstream occurs more readily. The use of this therapy is also done for conditions that don’t involve specific respiratory diseases, such as partial blockage of the upper airway by cancerous tumors, and swelling of the throat due to anaphylaxis or allergic reactions.
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What Is The Role Of Heliox In The Treatment Of Asthma
Heliox is a helium-oxygen mixture that may provide dramatic benefit for ED patients with severe exacerbations. Helium is about 10% as dense as room air and, consequently, travels more easily down narrowed passages. This property makes heliox of particular value to patients at risk of intubationby quickly decreasing the work of breathing and, when the gas mixture is used to drive the nebulizer, by better delivery of the inhaled bronchodilator.
What Other Uses Does Heliox Have
Heliox is also used in patients with large airway obstructions , croup or COPD. Because Heliox is easier to breathe, it reduces work of breathing meaning your patient is less likely to tire out and crump .
Its also used in the delivery of anesthesia and, outside of the medical field, its used in deep sea diving. So all in all, its pretty cool stuff.
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Clinical Effects Of Heliox
Heliox is a mixture of oxygen and helium. Heliox has a density less than air and a viscosity greater than air. For instance, a mixture of 20% oxygen and 80% helium has a density of 0.33 relative to air and a viscosity of 1.08 relative to air.64 Because gas density influences the resistance during turbulent flow, this gas mixture can be especially beneficial in patients who have upper airway narrowing .86 Substituting heliox for air or oxygen reduces gas density, lowering the Reynolds number, and helps to convert turbulent to laminar flow. This reduces the pressure required to move gas through the airways and diminishes the work of breathing, unloading the respiratory muscles.
Heliox may be useful in patients with asthma or COPD, although this is controversial.87-89 The reason for a beneficial effect is unclear, because flow in the smaller bronchioles, which contribute most of the increased airways resistance in asthma and COPD, should be laminar rather than turbulent. The effectiveness of heliox in asthma might be related to narrowing of large central airways from secretions and conversion of flow from turbulent to laminar in larger airways. Heliox might also be beneficial in vocal cord dysfunction for a similar reason.
Thomas C. Corbridge, Susan J. Corbridge, in, 2008
Personally This Is What I Think:
- I consider Heliox in any patient that has severe increased work of breathing and who hasnt improved with 1st and 2nd line therapies. The patient who comes in looking like the need to be intubated emergently is not the patient that gets Heliox first they get intubated. But the kid who is still in severe respiratory distress after your 1st line meds and maneuvers and is still looking like they have some residual fight let in them, then Heliox may give them the edge they need to get through this without a big piece of plastic in their airway. It is in the Kitchen Sick with other fun things like Magnesium and BiPap.
- Particularly with those conditions that the process of intubating may not be super easy or in those who being mechanically ventilated is potentially hazardous .
- A trial of Heliox will either help the patient and save them from intubation or it wont and then you know what needs to be done. So I dont appreciate that it has a significant down-side. AS LONG AS THE PATIENT DOESNT NEED HIGH OXYGEN CONCENTRATIONS.
Sean M. Fox
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Chronic Obstructive Pulmonary Disease
Heliox has been used in both nonintubated and intubated COPD patients. NIV has become the standard initial treatment in the majority of such patients . COPD patients in acute decompensation are at risk for respiratory failure precipitated by an increase in their WOB, leading to inspiratory muscle fatigue. NIV decreases the WOB in these patients . Therefore, it was hypothesized that the WOB associated with NIV could be further reduced by combining that form of ventilation with heliox. Two studies have been reported that support this hypothesis. However, the proof that NIV with heliox is superior to NIV with an airoxygen mixture in avoiding intubation in COPD patients is nevertheless lacking. We are aware of two ongoing multicentre trials in Europe that are attempting to resolve this issue. Until the results of those studies are known, it seems wise to refrain from introducing heliox into routine practice because of the costs of the gas.
Other Research On The Use Of Heliox
Nebulized drug delivery
Helium-driven albuterol would be expected to increase nebulized drug delivery, and improve gas exchange to the distal airways. Bigham et al., investigated the effect of heliox-powered albuterol therapy on hospital length of stay and clinical status in children with moderate to severe status asthmaticus. According to that study, heliox-powered nebulized albuterol therapy for children admitted to the hospital with moderate to severe status asthmaticus does not shorten hospital length of stay or hasten rates of clinical improvement when compared with air/oxygen-powered nebulized albuterol. A study performed to compare the bronchodilator effects of albuterol and ipratropium bromide through nebulization is driven by heliox with that if driven by compressed room air during the treatment of acute exacerbation of COPD. The change in percentage of predicted forced expiratory flow after 25-75% of vital capacity that had been expelled , and forced expiratory volume in 1 s were measured. According to this study, use of heliox as a driving gas for the updraft nebulization of bronchodilators during the first 2 h of treatment of an acute COPD exacerbation failed to improve FEV1 faster than the use of AIR. The faster improvement in FEF25-75 during the first 2 h of treatment was small and of uncertain clinical significance.
Severe respiratory failure
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The Effect Of Heliox On Lung Mechanics And Inflammation In Animal Models Of Ards
We found 3 articles describing the effect of heliox on gas exchange in paediatric animal models and 3 studies using adult animal models.
Neonatal RDS Animal Models
In a study in neonatal piglets with ARDS induced by saline lavage, animals were ventilated with 40 or 60% helium balanced with oxygen in a high-frequency oscillatory ventilation mode with fixed mean airway pressure, oscillation amplitude and frequency . The ventilation settings were targeted to reach PaCO2 levels of 55-80 mm Hg and a PaO2 level above 100 mm Hg. Heliox resulted in decreased PaCO2 levels, combined with a modest improved oxygenation, together with an increased tidal volume delivery, as measured by a pneumotachometer. As increased tidal volume delivery is unwanted in neonatal RDS, the effect of heliox on gas exchange was investigated while keeping the tidal volume constant. Swine with saline lavage-induced ARDS were ventilated with 40% helium or 40% nitrogen while tidal volume was kept constant by adjusting the oscillation amplitude . At a constant tidal volume, helium did not alter oxygenation. However, the oscillation amplitude did decrease significantly during heliox ventilation, which relates to a decrease in the peak inspiratory pressure .
In summary, in paediatric animal models of ARDS ventilated in an HFOV mode, heliox improved gas exchange while allowing for less invasive ventilation, with a concomitant reduction in lung inflammation .
ARDS Animal Models
Technical And Cost Issues May Discourage Widespread Use For Now
Several words should be added regarding the technical and the financial issues associated with the use of helium. In spontaneously breathing patients, heliox should be administered with a nonrebreather face mask, and if necessary oxygen can be added through a nasal canula. The use of heliox with a ventilator raises various technical and safety issues that need to be resolved before we can begin to use this mixture of gas in ventilated patients .
Finally, even if helium is the second most abundant element in the universe, the extraction and processing costs on Earth are high. In Switzerland, a 60-l tank of 78:22 heliox pressurized at 200 Bars costs US$275. However, these high costs should be balanced against the benefits, such as improving patient outcome and reducing the duration of intensive care unit stay. Such issues should be addressed in further studies into heliox therapy.
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Heliox Therapy For Asthma
El-Khatib MF, et al. Effect of heliox- and air-driven nebulized bronchodilator therapy on lung function in patients with asthma. Lung. 2014 Jun 192:377-83.
In conclusion, for asthmatic patients with baseline FEV1 50 %, albuterol nebulized with heliox leads to more significant improvements in spirometry measurementswhen compared to albuterol nebulized with air. This is likely due to the low-density gas improving albuterol deposition in the distal airways. However, heliox-driven nebulization of albuterol might not provide significant improvements in spirometry measurements and any other clinical benefits over air-driven bronchodilation in stable asthmatic patients with baseline FEV1 > 150 %. Heliox-driven nebulized bronchodilator use may be considered for reversibility testing in asthmatics with baseline FEV1 < 50 %.
This review suggests that heliox benefits in airflow limitation and hospital admissions could be considered clinically significant. Data support the use of heliox as a nebulizing 2-agonist driving gas in the routine care of patients with acute asthma.
Full-text for Emory users.
Murata A, Ling PM. Asthma diagnosis and management. Emerg Med Clin North Am. 2012 May 30:203-22, vii.
Brandão DC, Britto MC, Pessoa MF, et al. Heliox and forward-leaning posture improve the efficacy of nebulized bronchodilator in acute asthma: a randomized trial. Respir Care. 2011 Jul 56:947-52.
What Is Heliox Therapy Used For
In respect to this, what is Heliox therapy and how does it work?
Heliox, a mixture of helium and oxygen, has a density that is less than that of air. Breathing heliox leads to a reduction in resistance to flow within the airways, and consequently to a decrease in the work of breathing , particularly in disorders that are characterized by increased airways resistance.
Subsequently, question is, is heliox flammable? Flammability: Heliox is non- flammable but supports combustion of common combustible materials. For mixtures greater than 21% oxygen vigorously supports combustion of many materials which will not normally burn in air.
Also, how is heliox administered?
Heliox can be administered via a well-fitting face mask at flows high enough to prevent entrainment of room air. Therefore, an 80/20 mixture of helium-oxygen is most effective.
Is helium bad for asthma?
The helium helped Zach’s breathing return to normal, and he’s been good to go ever since. Dr. Swift says the worst cases of asthma are often in kids five to 18, and if not treated, some cases can lead to heart failure.
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Your Patient Is On Heliox For Asthma Now What
If your patient is on Heliox for asthma, you need to:
With good nursing and respiratory care, your patient will likely improve within hours. As this occurs, your RT will wean down the Heliox. Keep a close eye on your patient, communicating any abnormal findings with your therapist. Working as a team, youll get your patient back to normal in no time. Way to go!
Breathing Helium Decreases Work Of Breathing
In turbulent flows, the pressure necessary to generate a given flow rate is dependent on the density of the inspired gases . Helium has a density that is significantly lower than that of air . Therefore, a mixture of helium and oxygen, termed heliox, has a lower density than does a mixture of nitrogen and oxygen . Breathing heliox leads to a reduction in resistance to flow within the airways, and consequently to a decrease in the WOB, particularly in disorders that are characterized by increased airways resistance . These beneficial effects have been observed in a few patients with asthma, chronic obstructive pulmonary disease , bronchiolitis, bronchopulmonary dysplasia and upper airways obstruction . Heliox has not only been used in patients breathing spontaneously, but also in the settings of both invasive mechanical ventilation and noninvasive mechanical ventilation . Nevertheless, the usefulness of heliox in the intensive care unit remains debatable.
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What Is Heliox Therapy And How Does It Work
Correspondingly, what is Heliox therapy used for?
Heliox has also been used in COPD patients once intubated and mechanically ventilated, in order to reduce intrinsic positive end-expiratory pressure and hyperinflation, and to lessen the impact of high alveolar pressure on haemodynamic and respiratory mechanics .
Also, why do divers use heliox? The main reason for adding helium to the breathing mix is to reduce the proportions of nitrogen and oxygen below those of air, to allow the gas mix to be breathed safely on deep dives. A lower proportion of nitrogen is required to reduce nitrogen narcosis and other physiological effects of the gas at depth.
Also question is, how is heliox administered?
Heliox can be administered via a well-fitting face mask at flows high enough to prevent entrainment of room air. Therefore, an 80/20 mixture of helium-oxygen is most effective.
Is heliox flammable?
Flammability: Heliox is non- flammable but supports combustion of common combustible materials. For mixtures greater than 21% oxygen vigorously supports combustion of many materials which will not normally burn in air.