The Role of Heliox in Intensive Care Fekri Abroug CHU F.Bourguiba Monastir. Tunisia.
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The Role of Heliox in Intensive The Role of Heliox in Intensive Care Care Fekri Abroug CHU F.Bourguiba Monastir. Tunisia
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Heliox n Discovered in 1895 n 1934 used for airway obstruction (Barach) n Limited use if pt needs O 2 n Try to deliver at least 60% helium, ideally 80% West JB, Respiratory Physiology, The Essentials, 6 th ed. 2000, Lippincott, p. 91.
Transcript of The Role of Heliox in Intensive Care Fekri Abroug CHU F.Bourguiba Monastir. Tunisia.
The Role of Heliox in Intensive CareThe Role of Heliox in Intensive Care
Fekri AbrougCHU F.BourguibaMonastir. Tunisia
Helium + Oxygen = HelioxHelium + Oxygen = Heliox
Helium- inert low MW gas, insoluble at 1 ATM
low density (0.179 μ poise) vs. air (1.293) and O2 (1.429)
density- turbulent flow
HelioxHeliox Discovered in 1895 1934 used for airway obstruction
(Barach) Limited use if pt needs O2
Try to deliver at least 60% helium, ideally 80%
West JB, Respiratory Physiology, The Essentials, 6th ed. 2000, Lippincott, p. 91.
Heliox in acute asthmaHeliox in acute asthma
Pathophysiology in asthmaPathophysiology in asthma
Effects of HelioxEffects of Heliox
Reduces the Work of Breathing Reduces the pic pressure Reduces the dynamic hyperinflation
(auto-PEP)
7 heterogeneous studies:– 4 studies where heliox served as a vector
of nebuliserd ß2-agonists– 3 studies where heliox replaced air– 4 studies where heliox/air mixture: 80/20– 3 studies where heliox/air mixture : 70/30– Administration duration: 15-480 minutes– 6 randomised studies, 1 non randomised
PEF was not systematically corrected (1.32)
Overall: poor methodologic quality
Heliox in non-intubated Heliox in non-intubated asthmaticsasthmaticsEffects on pulmonary functionEffects on pulmonary function
Rodrigo. Cochrane Database jan 2005
Heliox in non-intubated Heliox in non-intubated asthmaticsasthmaticsEffects on hospital Effects on hospital admissionsadmissions
HelioxHeliox No effect on pulmonary function
although heterogeneous studies (trend toward favourable effect when Heliox is used for drug nebulisation)
Enhances the pulsus parodoxus in a pediatric study
No effect on admissions rate
The studyThe study evaluating Heliox in evaluating Heliox in acute asthma remains to be acute asthma remains to be
performedperformedManthous. Chest 2003Manthous. Chest 2003
Only patients without improvement following the first ß2-agonists should be included (70% of overall population improve their respiratory function followin the first bronchodilator nebulisation
The study should include a large sample size (654 patients to demonstrate a reduction in the intubation rate from 1 to 0.2% (ß=80% & α=0.05)
Heliox in the prehospital settingHeliox in the prehospital setting Baseline evaluationBaseline evaluation
PEF O2 N=97
He-O2 N=96
Mean 91.8 121.9 Median 90 110 Min / Max 0 / 300 0 / 330
PEF/ PEFtheo. O2 He-O2 Mean 21.8 28.8 Median 23.5 25.5
PEF variation (medians)PEF variation (medians)Correction (1.32)Correction (1.32)
100120
150
250
190
290
192
330
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50
100
150
200
250
300
350
T0 T2 T3 T4
O2 (N=64)He-O2(N=67)
Heliox Acute Exacerbation of Heliox Acute Exacerbation of COPDCOPD
International Multicentric study: International Multicentric study:
NIV/ Heliox in AECOPDNIV/ Heliox in AECOPD International Multicentric Study: 2000-2002
– 5 French Centers– 1 Spanish Center– 1 Italian Center– 1 Tunisian Center
A prospective Controlled Study: Airox vs Heliox Heliox administartion duration: duration of NIV Evaluation Outcome: reduction in the intubation rate
from 40% to 20% (estimated sample size: 200)
Heliox & NIV VentilationHeliox & NIV Ventilation Many ventilators are not calibrated
for Helium and underestimate TV.
Bouton de ContrôleInterrupteur marche/arrêt
Réglage FIO2
Touche MENU B50B50Prise O2
Détendeur Inverseur Détendeur
Héliox HélioxAlimentation
OXYGENE du 760
Bouton de ContrôleInterrupteur marche/arrêt
Réglage FIO2
Touche MENU B50B50Prise O2
Détendeur Inverseur Détendeur
Héliox HélioxAlimentation
OXYGENE du 760
Patients characteristicsPatients characteristics
AiroxN= 99
HelioxN=96
pH 7.28±0.06 7.28±0.07
PaCO2 71.7±15 73.3±18
SAPS II 33±11 32±11
Effects on intubation rateEffects on intubation rate
Reduction of the intubation rate: 30.3% à 20.8% (p=0.13)
RRA: 10% (95%CI: -3%-21%)
NNT: 10 (95%CI: 5-33)
0.00 0.05 0.10 0.15 0.20 0.25 0.300
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Intubation: 20% (airox) vs 13% (heliox) Hospitalisation costs: reduction of
3348$/patient
Meta-analysis: NIV Heliox-Meta-analysis: NIV Heliox-AECOPDAECOPD
Reduction of the intubation rate: 26% to 18%(p=0.09)
ARR: 8% (95%CI: -0.8%-17%)
NNT:12(95%CI: 6-100)
Abroug &al (in press)
Greetings Greetings from from
MonastirMonastir
