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Gilles Cambonie - One of the best experts on this subject based on the ideXlab platform.
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Heliox inhalation therapy for bronchiolitis in infants.
The Cochrane database of systematic reviews, 2015Co-Authors: Jean-michel Liet, Vineet Gupta, Thierry Ducruet, Gilles CambonieAbstract:Bronchiolitis is the leading cause of hospitalisation among infants in high-income countries. Acute viral bronchiolitis is associated with airway obstruction and turbulent gas flow. Heliox, a mixture of oxygen and the inert gas helium, may improve gas flow through high-resistance airways and decrease the work of breathing. In this review, we selected trials that objectively assessed the effect of the addition of Heliox to standard medical care for acute bronchiolitis. To assess Heliox inhalation therapy in addition to standard medical care for acute bronchiolitis in infants with respiratory distress, as measured by clinical endpoints (in particular the rate of endotracheal intubation, the rate of emergency department discharge, the length of treatment for respiratory distress) and pulmonary function testing (mainly clinical respiratory scores). We searched CENTRAL (2015, Issue 2), MEDLINE (1966 to March week 3, 2015), EMBASE (1974 to March 2015), LILACS (1982 to March 2015) and the National Institutes of Health (NIH) website (May 2009). Randomised controlled trials (RCTs) and quasi-RCTs of Heliox in infants with acute bronchiolitis. Two review authors independently extracted data and assessed trial quality. We included seven trials involving 447 infants younger than two years with respiratory distress secondary to viral bronchiolitis. All children were recruited from a paediatric intensive care unit (PICU; 378 infants), except in one trial (emergency department; 69 infants). All children were younger than two (under nine months in two trials and under three months in one trial). Positive tests for respiratory syncytial virus (RSV) were required for inclusion in five trials. The two other trials were carried out in the bronchiolitis seasons. Seven different protocols were used for inhalation therapy with Heliox.When Heliox was used in the PICU, we observed no significant reduction in the rate of intubation: risk ratio (RR) 2.73 (95% confidence interval (CI) 0.96 to 7.75, four trials, 408 infants, low quality evidence). When Heliox inhalation was used in the emergency department, we observed no increase in the rate of discharge: RR 0.51 (95% CI 0.17 to 1.55, one trial, 69 infants, moderate quality evidence).There was no decrease in the length of treatment for respiratory distress: mean difference (MD) -0.19 days (95% CI -0.56 to 0.19, two trials, 320 infants, moderate quality evidence). However, in the subgroup of infants who were started on nasal continuous positive airway pressure (nCPAP) right from the start, because of severe respiratory distress, Heliox therapy reduced the length of treatment: MD -0.76 days (95% CI -1.45 to -0.08, one trial, 21 infants, low quality evidence). No adverse events related to Heliox inhalation were reported.We found that infants treated with Heliox inhalation had a significantly lower mean clinical respiratory score in the first hour after starting treatment when compared to those treated with air or oxygen inhalation: MD -1.04 (95% CI -1.60 to -0.48, four trials, 138 infants, moderate quality evidence). This outcome had statistical heterogeneity, which remained even after removing the study using a standard high-concentration reservoir mask. Several factors may explain this heterogeneity, including first the limited number of patients in each trial, and the wide differences in the baseline severity of disease between studies, with the modified Wood Clinical Asthma Score (m-WCAS) in infants treated with Heliox ranging from less than two to more than seven. Current evidence suggests that the addition of Heliox therapy may significantly reduce a clinical score evaluating respiratory distress in the first hour after starting treatment in infants with acute RSV bronchiolitis. We noticed this beneficial effect regardless of which Heliox inhalation protocol was used. Nevertheless, there was no reduction in the rate of intubation, in the rate of emergency department discharge, or in the length of treatment for respiratory distress. Heliox could reduce the length of treatment in infants requiring CPAP for severe respiratory distress. Further studies with homogeneous logistics in their Heliox application are needed. Inclusion criteria must include a clinical severity score that reflects severe respiratory distress to avoid inclusion of children with mild bronchiolitis who may not benefit from Heliox inhalation. Such studies would provide the necessary information as to the appropriate place for Heliox in the therapeutic schedule for severe bronchiolitis.
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Heliox inhalation therapy for bronchiolitis in infants
Cochrane database of systematic reviews (Online), 2015Co-Authors: Jean-michel Liet, Vineet Gupta, Thierry Ducruet, Gilles CambonieAbstract:BACKGROUND: Bronchiolitis is the leading cause of hospitalisation among infants in high-income countries. Acute viral bronchiolitis is associated with airway obstruction and turbulent gas flow. Heliox, a mixture of oxygen and the inert gas helium, may improve gas flow through high-resistance airways and decrease the work of breathing. In this review, we selected trials that objectively assessed the effect of the addition of Heliox to standard medical care for acute bronchiolitis. OBJECTIVES: To assess Heliox inhalation therapy in addition to standard medical care for acute bronchiolitis in infants with respiratory distress, as measured by clinical endpoints (in particular the rate of endotracheal intubation, the rate of emergency department discharge, the length of treatment for respiratory distress) and pulmonary function testing (mainly clinical respiratory scores). SEARCH METHODS: We searched CENTRAL (2015, Issue 2), MEDLINE (1966 to March week 3, 2015), EMBASE (1974 to March 2015), LILACS (1982 to March 2015) and the National Institutes of Health (NIH) website (May 2009). SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs of Heliox in infants with acute bronchiolitis. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed trial quality. MAIN RESULTS: We included seven trials involving 447 infants younger than two years with respiratory distress secondary to viral bronchiolitis. All children were recruited from a paediatric intensive care unit (PICU; 378 infants), except in one trial (emergency department; 69 infants). All children were younger than two (under nine months in two trials and under three months in one trial). Positive tests for respiratory syncytial virus (RSV) were required for inclusion in five trials. The two other trials were carried out in the bronchiolitis seasons. Seven different protocols were used for inhalation therapy with Heliox.When Heliox was used in the PICU, we observed no significant reduction in the rate of intubation: risk ratio (RR) 2.73 (95% confidence interval (CI) 0.96 to 7.75, four trials, 408 infants, low quality evidence). When Heliox inhalation was used in the emergency department, we observed no increase in the rate of discharge: RR 0.51 (95% CI 0.17 to 1.55, one trial, 69 infants, moderate quality evidence).There was no decrease in the length of treatment for respiratory distress: mean difference (MD) -0.19 days (95% CI -0.56 to 0.19, two trials, 320 infants, moderate quality evidence). However, in the subgroup of infants who were started on nasal continuous positive airway pressure (nCPAP) right from the start, because of severe respiratory distress, Heliox therapy reduced the length of treatment: MD -0.76 days (95% CI -1.45 to -0.08, one trial, 21 infants, low quality evidence). No adverse events related to Heliox inhalation were reported.We found that infants treated with Heliox inhalation had a significantly lower mean clinical respiratory score in the first hour after starting treatment when compared to those treated with air or oxygen inhalation: MD -1.04 (95% CI -1.60 to -0.48, four trials, 138 infants, moderate quality evidence). This outcome had statistical heterogeneity, which remained even after removing the study using a standard high-concentration reservoir mask. Several factors may explain this heterogeneity, including first the limited number of patients in each trial, and the wide differences in the baseline severity of disease between studies, with the modified Wood Clinical Asthma Score (m-WCAS) in infants treated with Heliox ranging from less than two to more than seven. UTHORS' CONCLUSIONS: Current evidence suggests that the addition of Heliox therapy may significantly reduce a clinical score evaluating respiratory distress in the first hour after starting treatment in infants with acute RSV bronchiolitis. We noticed this beneficial effect regardless of which Heliox inhalation protocol was used. Nevertheless, there was no reduction in the rate of intubation, in the rate of emergency department discharge, or in the length of treatment for respiratory distress. Heliox could reduce the length of treatment in infants requiring CPAP for severe respiratory distress. Further studies with homogeneous logistics in their Heliox application are needed. Inclusion criteria must include a clinical severity score that reflects severe respiratory distress to avoid inclusion of children with mild bronchiolitis who may not benefit from Heliox inhalation. Such studies would provide the necessary information as to the appropriate place for Heliox in the therapeutic schedule for severe bronchiolitis
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The Cochrane Library - Heliox inhalation therapy for bronchiolitis in infants
The Cochrane database of systematic reviews, 2010Co-Authors: Jean-michel Liet, Vineet Gupta, Thierry Ducruet, Gilles CambonieAbstract:Background Bronchiolitis is the leading cause of hospitalisation among infants in high-income countries. Acute viral bronchiolitis is associated with airway obstruction and turbulent gas flow. Heliox, a mixture of oxygen and the inert gas helium, may improve gas flow through high-resistance airways and decrease the work of breathing. In this review, we selected trials that objectively assessed the effect of the addition of Heliox to standard medical care for acute bronchiolitis. Objectives To assess Heliox inhalation therapy in addition to standard medical care for acute bronchiolitis in infants with respiratory distress, as measured by clinical endpoints (in particular the rate of endotracheal intubation, the rate of emergency department discharge, the length of treatment for respiratory distress) and pulmonary function testing (mainly clinical respiratory scores). Search methods We searched CENTRAL (2015, Issue 2), MEDLINE (1966 to March week 3, 2015), EMBASE (1974 to March 2015), LILACS (1982 to March 2015) and the National Institutes of Health (NIH) website (May 2009). Selection criteria Randomised controlled trials (RCTs) and quasi-RCTs of Heliox in infants with acute bronchiolitis. Data collection and analysis Two review authors independently extracted data and assessed trial quality. Main results We included seven trials involving 447 infants younger than two years with respiratory distress secondary to viral bronchiolitis. All children were recruited from a paediatric intensive care unit (PICU; 378 infants), except in one trial (emergency department; 69 infants). All children were younger than two (under nine months in two trials and under three months in one trial). Positive tests for respiratory syncytial virus (RSV) were required for inclusion in five trials. The two other trials were carried out in the bronchiolitis seasons. Seven different protocols were used for inhalation therapy with Heliox. When Heliox was used in the PICU, we observed no significant reduction in the rate of intubation: risk ratio (RR) 2.73 (95% confidence interval (CI) 0.96 to 7.75, four trials, 408 infants, low quality evidence). When Heliox inhalation was used in the emergency department, we observed no increase in the rate of discharge: RR 0.51 (95% CI 0.17 to 1.55, one trial, 69 infants, moderate quality evidence). There was no decrease in the length of treatment for respiratory distress: mean difference (MD) -0.19 days (95% CI -0.56 to 0.19, two trials, 320 infants, moderate quality evidence). However, in the subgroup of infants who were started on nasal continuous positive airway pressure (nCPAP) right from the start, because of severe respiratory distress, Heliox therapy reduced the length of treatment: MD -0.76 days (95% CI -1.45 to -0.08, one trial, 21 infants, low quality evidence). No adverse events related to Heliox inhalation were reported. We found that infants treated with Heliox inhalation had a significantly lower mean clinical respiratory score in the first hour after starting treatment when compared to those treated with air or oxygen inhalation: MD -1.04 (95% CI -1.60 to -0.48, four trials, 138 infants, moderate quality evidence). This outcome had statistical heterogeneity, which remained even after removing the study using a standard high-concentration reservoir mask. Several factors may explain this heterogeneity, including first the limited number of patients in each trial, and the wide differences in the baseline severity of disease between studies, with the modified Wood Clinical Asthma Score (m-WCAS) in infants treated with Heliox ranging from less than two to more than seven. Authors' conclusions Current evidence suggests that the addition of Heliox therapy may significantly reduce a clinical score evaluating respiratory distress in the first hour after starting treatment in infants with acute RSV bronchiolitis. We noticed this beneficial effect regardless of which Heliox inhalation protocol was used. Nevertheless, there was no reduction in the rate of intubation, in the rate of emergency department discharge, or in the length of treatment for respiratory distress. Heliox could reduce the length of treatment in infants requiring CPAP for severe respiratory distress. Further studies with homogeneous logistics in their Heliox application are needed. Inclusion criteria must include a clinical severity score that reflects severe respiratory distress to avoid inclusion of children with mild bronchiolitis who may not benefit from Heliox inhalation. Such studies would provide the necessary information as to the appropriate place for Heliox in the therapeutic schedule for severe bronchiolitis.
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Clinical effects of Heliox administration for acute bronchiolitis in young infants.
Chest, 2006Co-Authors: Gilles Cambonie, Christophe Milési, Sébastien Fournier-favre, Franċois Counil, Samir Jaber, Jean-charles Picaud, Stefan MateckiAbstract:Objective: To assess the effect of Heliox, a helium-oxygen mixture, on respiratory distress symptoms in young infants. Design: Prospective, randomized, double-blind study. Setting: Pediatric ICU (PICU) of a university hospital. Patients: Twenty infants, all < 3 months old, admitted to the PICU with moderate-to-severe acute respiratory syncytial virus bronchiolitis. Interventions: All infants were randomly and blindly assigned to inhale either Heliox or an air-oxygen mixture (airox) for 1 h under an oxyhood. Measurements and results: After 1 h, the respiratory distress score was significantly lower in the Heliox group compared with the airox group (3.05 vs 5.5, p < 0.01), with a significant reduction in accessory muscles use (p < 0.05) and expiratory wheezing (p < 0.01). In contrast, inspiratory breath sounds and cyanosis did not significantly differ between groups. The ex-premature infants of the Heliox group had a higher respiratory distress score at baseline compared with the term infants of this group (5.8 vs 5.2, p < 0.05) and a comparable decrease in the score at 60 min. Conclusions: In young infants, even those born prematurely, Heliox breathing induced a rapid reduction in accessory muscles use and expiratory wheezing. Further studies are needed to confirm the decreased respiratory muscle work of breathing during Heliox inhalation in this population.
Martin Müller - One of the best experts on this subject based on the ideXlab platform.
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Delivery of Heliox with a semi-closed circuit during spontaneous breathing: a comparative economic theoretical study
BMC pulmonary medicine, 2015Co-Authors: Ivana Jurickova, Karel Roubik, Martin MüllerAbstract:Heliox is a mixture of oxygen and helium which reduces airway resistance in patients with airway obstruction. In clinical practice, patients breathing spontaneously receive Heliox via an open circuit. Recently, a semi-closed circuit for Heliox administration has been proposed which minimizes consumption of Heliox and therefore cost of the Heliox therapy; although, the semi-closed circuit is associated with additional costs. The aim of the study is to conduct an economical analysis comparing total cost of Heliox therapy using an open versus a semi-closed circuit in spontaneously breathing patients with airway obstruction. Four different systems for Heliox administration were analyzed: an open circuit and three alternatives of a semi-closed circuit involving a custom made semi-closed circuit and two standard anesthesia machines. Total costs of Heliox therapy were calculated for all the systems. For calculation of gas consumption, the clinical procedures limiting continuous Heliox therapy including the aerosol therapy, personal hygiene and nutrition were taken into account. A sensitivity analysis was conducted for main input variables that may influence the results of the study. Price of gases consumed by a semi-closed system represents less than 20 % of price of gases when a standard open circuit is used. This represents a saving of approximately 540 EUR per patient. The initial cost of the custom-made semi-closed circuit recuperates after treatment of 18 patients. The corresponding number of patients is 32 when a low-cost anesthesia machine is initially acquired and rises to 69 when a highly advanced anesthesia machine is considered. Heliox therapy in spontaneously breathing patients using a semi-closed circuit becomes more cost-effective compared to the open circuit, currently used in clinical practice, when applied in a sufficient number of cases. The impact of finding a cheaper way of Heliox administration on the clinical practice needs to be ascertained.
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Spontaneous breathing of Heliox using a semi-closed circuit: A bench study
The International journal of artificial organs, 2012Co-Authors: Karel Roubik, R Zazula, Adela Strnadova, Vladimír Zábrodský, Antonín Spálený, Martin Müller, Jan Chlumský, Tomas TyllAbstract:INTRODUCTION The use of helium-oxygen mixture (Heliox) for ventilation has an advantage in patients with obstruction of the airways. The physical properties of helium enable an easier gas flow through the airways; this enables easier breathing for the patient when compared to standard ventilation of air. A high cost of Heliox falls within the factors that limit the use of Heliox in clinical practice. At present, Heliox is administered by use of an open circuit. The aim of this study is to propose a way of Heliox administration that reduces Heliox consumption but does not affect the positive Heliox effects upon the airway resistance. METHODS To minimize consumption of Heliox, a semi-closed circuit has been designed. The circuit is a modification of an anesthetic circuit composed of parts with the lowest possible resistances. As any circuit has its own resistance, the evaluation of its possible negative effect upon the work of breathing of patients with exacerbation of chronic obstructive pulmonary disease (COPD) has been conducted. RESULTS A semi-closed circuit for Heliox administration has been constructed and evaluated. The intrinsic resistance of both the inspiratory and expiratory limbs of the circuit is less than 140 Pa.s/l. This resistance does not represent a significant workload for a patient with COPD exacerbation whose airway resistance is 10 to 20 fold higher. CONCLUSIONS The designed semi-closed circuit offers a potential benefit of Heliox in patients with COPD exacerbation.
Jesse B. Hall - One of the best experts on this subject based on the ideXlab platform.
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use of Heliox delivered via high flow nasal cannula to treat an infant with coronavirus related respiratory infection and severe acute air flow obstruction
Respiratory Care, 2014Co-Authors: Sherwin E. Morgan, Jesse B. Hall, Kirissa Vukin, Steve Mosakowski, Patti Solano, Lolita Stanton, Lucille A Lester, Romeen Lavani, Avery TungAbstract:Heliox, a helium-oxygen gas mixture, has been used for many decades to treat obstructive pulmonary disease. The lower density and higher viscosity of Heliox relative to nitrogen-oxygen mixtures can significantly reduce airway resistance when an anatomic upper air-flow obstruction is present and gas flow is turbulent. Clinically, Heliox can decrease airway resistance in acute asthma in adults and children and in COPD. Heliox may also enhance the bronchodilating effects of β-agonist administration for acute asthma. Respiratory syndromes caused by coronavirus infections in humans range in severity from the common cold to severe acute respiratory syndrome associated with human coronavirus OC43 and other viral strains. In infants, coronavirus infection can cause bronchitis, bronchiolitis, and pneumonia in variable combinations and can produce enough air-flow obstruction to cause respiratory failure. We describe a case of coronavirus OC43 infection in an infant with severe acute respiratory distress treated with Heliox inhalation to avoid intubation.
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The utility of albuterol nebulized with Heliox during acute asthma exacerbations.
American journal of respiratory and critical care medicine, 2002Co-Authors: John P. Kress, Imre Noth, Brian K. Gehlbach, Nitin Barman, Anne S. Pohlman, Annette Miller, Sherwin E. Morgan, Jesse B. HallAbstract:Heliox improves lung deposition of inhaled particles when compared with air or oxygen inhalation. We studied the spirometric effects of albuterol nebulized with Heliox during emergency room visits for asthma exacerbations. Forty-five patients were randomized to receive albuterol nebulized with oxygen (control) versus Heliox (n = 22 control and 23 Heliox subjects). At baseline, demographics, outpatient asthma medications, vital signs, oxygen saturation, and forced expiratory volume in one second were not different between the two groups. Three consecutive albuterol treatments were given to each group. The Heliox group had a significantly higher heart rate after albuterol nebulization compared with the control group. Following albuterol Treatment 1, the median change in forced expiratory volume in one second was 14.6% in the control group and 32.4% in the Heliox group (p = 0.007). After Treatment 2, the results were 22.7% versus 51.5%, respectively (p = 0.007). After Treatment 3, the results were 26.6% vers...
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Heliox improves pulsus paradoxus and peak expiratory flow in nonintubated patients with severe asthma.
American Journal of Respiratory and Critical Care Medicine, 1995Co-Authors: Constantine A. Manthous, Jesse B. Hall, Ari Melmed, Mark A. Caputo, James Walter, James M. Klocksieben, Gregory A. Schmidt, Lawrence D. H. WoodAbstract:Heliox is a blend of helium and oxygen with a gas density less than that of air that decreases airway resistance (Raw) in patients ventilated for status asthmaticus. We tested whether breathing an 80:20 mixture of helium:oxygen would reduce pulsus paradoxus (PP) and increase peak expiratory flow (PEF) in patients presenting to the emergency room with an exacerbation of asthma. After receiving 30 min of beta-agonist aerosols and intravenously administered methylprednisolone, 27 patients whose PP remained greater than 15 mm Hg and whose PEF remained less than 250 L/min consented to breathe Heliox or room air for 15 min. PP decreased and PEF increased with time in control patients, indicating a time-related effect of routine bronchodilator therapy (p < 0.05). PP decreased in 15 of 16 patients during Heliox, and the change with Heliox was significantly greater than that during air breathing (p < 0.01). PEF measured with a Wright's peak flow meter calibrated for Heliox increased in all patients breathing helio...
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Heliox improves pulsus paradoxus and peak expiratory flow in nonintubated patients with severe asthma.
American journal of respiratory and critical care medicine, 1995Co-Authors: Constantine A. Manthous, Jesse B. Hall, Mark A. Caputo, James Walter, James M. Klocksieben, Gregory A. Schmidt, Lawrence D. H. WoodAbstract:Heliox is a blend of helium and oxygen with a gas density less than that of air that decreases airway resistance (Raw) in patients ventilated for status asthmaticus. We tested whether breathing an 80:20 mixture of helium:oxygen would reduce pulsus paradoxus (PP) and increase peak expiratory flow (PEF) in patients presenting to the emergency room with an exacerbation of asthma. After receiving 30 min of beta-agonist aerosols and intravenously administered methylprednisolone, 27 patients whose PP remained greater than 15 mm Hg and whose PEF remained less than 250 L/min consented to breathe Heliox or room air for 15 min. PP decreased and PEF increased with time in control patients, indicating a time-related effect of routine bronchodilator therapy (p < 0.05). PP decreased in 15 of 16 patients during Heliox, and the change with Heliox was significantly greater than that during air breathing (p < 0.01). PEF measured with a Wright's peak flow meter calibrated for Heliox increased in all patients breathing Heliox. Again, the increase in PEF during Heliox breathing was significantly greater than the corresponding change in control patients breathing air (p < 0.001). To the extent that PP reflects the inspiratory fall in pleural pressure, this reduction in PP indicates a substantial reduction in inspiratory Raw when the less dense gas is inspired through narrowed bronchi having turbulent flow regimes. The 35% increase in PEF while breathing Heliox signals a similar reduction in expiratory Raw, which might diminish the hyperinflation often observed during an exacerbation of asthma.(ABSTRACT TRUNCATED AT 250 WORDS)
Hubert Bland - One of the best experts on this subject based on the ideXlab platform.
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Heliox Therapy in Bronchiolitis: Phase III Multicenter Double-Blind Randomized Controlled Trial
Pediatrics, 2013Co-Authors: Mina M. Chowdhury, Sheila A. Mckenzie, Chris Pearson, Siobhán B. Carr, C. Pao, Arvind Shah, Elizabeth Reus, Joseph Eliahoo, Fabiana Gordon, Hubert BlandAbstract:WHAT’S KNOWN ON THIS SUBJECT: Bronchiolitis, a leading cause of infant hospitalization, has few proven treatments. A few small studies have reported the beneficial effects of a mixture of 21% oxygen + 79% helium (Heliox). The 2010 Cochrane Review concluded that additional large randomized controlled trials were needed to determine the therapeutic role of Heliox in bronchiolitis. WHAT THIS STUDY ADDS: The Bronchiolitis Randomized Controlled Trial Emergency-Assisted Therapy with Heliox—An Evaluation (BREATHE) trial is the largest multicenter randomized controlled trial to date to investigate the efficacy of Heliox in acute bronchiolitis. The delivery method for Heliox therapy was found to be crucial to its efficacy.
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the effects of Heliox on the output and particle size distribution of salbutamol using jet and vibrating mesh nebulizers
Journal of Aerosol Medicine-deposition Clearance and Effects in The Lung, 2007Co-Authors: Christopher Ocallaghan, Judy A White, Judith M Jackson, David Crosby, Beatriz Dougill, Hubert BlandAbstract:There are theoretical benefits of delivering drug aerosols to patients with asthma and chronic obstructive pulmonary disease (COPD) using Heliox as a carrier gas. The objective of this study was to develop systems to allow bronchodilators nebulized by a breath enhanced jet nebulizer and a vibrating mesh nebulizer to be delivered to patients in Heliox. This was achieved by attaching a reservoir to the nebulizers to ensure inhaled Heliox was not diluted by entrained air. For the vibrating mesh nebulizer, the total output was significantly higher after 5 min of nebulization when Heliox rather than air was used as the delivery gas (p < 0.001). The proportion of drug in particles <5 microm was 58.1% for Heliox and 50.1% when air was entrained. When the breath enhanced nebulizer was used a much higher driving flow of Heliox, compared to air, was required to deliver a similar dose of drug (p < 0.05). The total amount of drug likely to be inhaled was significantly higher when the vibrating mesh nebulizer (Aerogen) was used compared to the breath enhanced jet nebulizer (Pari LC plus) (p < 0.001). The amount of drug likely to be inhaled was also significantly greater for the adult as opposed to pediatric breathing pattern for all nebulizers and flows tested with the exception of the Aeroneb and Heliox entrainment. In this case, total amounts were similar for both patterns but for the pediatric pattern, the time taken to reach this output was longer. Such information is required to allow appropriate interpretation of clinical trials of drug delivery using Heliox.
Jean-michel Liet - One of the best experts on this subject based on the ideXlab platform.
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Heliox inhalation therapy for bronchiolitis in infants
Cochrane database of systematic reviews (Online), 2015Co-Authors: Jean-michel Liet, Vineet Gupta, Thierry Ducruet, Gilles CambonieAbstract:BACKGROUND: Bronchiolitis is the leading cause of hospitalisation among infants in high-income countries. Acute viral bronchiolitis is associated with airway obstruction and turbulent gas flow. Heliox, a mixture of oxygen and the inert gas helium, may improve gas flow through high-resistance airways and decrease the work of breathing. In this review, we selected trials that objectively assessed the effect of the addition of Heliox to standard medical care for acute bronchiolitis. OBJECTIVES: To assess Heliox inhalation therapy in addition to standard medical care for acute bronchiolitis in infants with respiratory distress, as measured by clinical endpoints (in particular the rate of endotracheal intubation, the rate of emergency department discharge, the length of treatment for respiratory distress) and pulmonary function testing (mainly clinical respiratory scores). SEARCH METHODS: We searched CENTRAL (2015, Issue 2), MEDLINE (1966 to March week 3, 2015), EMBASE (1974 to March 2015), LILACS (1982 to March 2015) and the National Institutes of Health (NIH) website (May 2009). SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs of Heliox in infants with acute bronchiolitis. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed trial quality. MAIN RESULTS: We included seven trials involving 447 infants younger than two years with respiratory distress secondary to viral bronchiolitis. All children were recruited from a paediatric intensive care unit (PICU; 378 infants), except in one trial (emergency department; 69 infants). All children were younger than two (under nine months in two trials and under three months in one trial). Positive tests for respiratory syncytial virus (RSV) were required for inclusion in five trials. The two other trials were carried out in the bronchiolitis seasons. Seven different protocols were used for inhalation therapy with Heliox.When Heliox was used in the PICU, we observed no significant reduction in the rate of intubation: risk ratio (RR) 2.73 (95% confidence interval (CI) 0.96 to 7.75, four trials, 408 infants, low quality evidence). When Heliox inhalation was used in the emergency department, we observed no increase in the rate of discharge: RR 0.51 (95% CI 0.17 to 1.55, one trial, 69 infants, moderate quality evidence).There was no decrease in the length of treatment for respiratory distress: mean difference (MD) -0.19 days (95% CI -0.56 to 0.19, two trials, 320 infants, moderate quality evidence). However, in the subgroup of infants who were started on nasal continuous positive airway pressure (nCPAP) right from the start, because of severe respiratory distress, Heliox therapy reduced the length of treatment: MD -0.76 days (95% CI -1.45 to -0.08, one trial, 21 infants, low quality evidence). No adverse events related to Heliox inhalation were reported.We found that infants treated with Heliox inhalation had a significantly lower mean clinical respiratory score in the first hour after starting treatment when compared to those treated with air or oxygen inhalation: MD -1.04 (95% CI -1.60 to -0.48, four trials, 138 infants, moderate quality evidence). This outcome had statistical heterogeneity, which remained even after removing the study using a standard high-concentration reservoir mask. Several factors may explain this heterogeneity, including first the limited number of patients in each trial, and the wide differences in the baseline severity of disease between studies, with the modified Wood Clinical Asthma Score (m-WCAS) in infants treated with Heliox ranging from less than two to more than seven. UTHORS' CONCLUSIONS: Current evidence suggests that the addition of Heliox therapy may significantly reduce a clinical score evaluating respiratory distress in the first hour after starting treatment in infants with acute RSV bronchiolitis. We noticed this beneficial effect regardless of which Heliox inhalation protocol was used. Nevertheless, there was no reduction in the rate of intubation, in the rate of emergency department discharge, or in the length of treatment for respiratory distress. Heliox could reduce the length of treatment in infants requiring CPAP for severe respiratory distress. Further studies with homogeneous logistics in their Heliox application are needed. Inclusion criteria must include a clinical severity score that reflects severe respiratory distress to avoid inclusion of children with mild bronchiolitis who may not benefit from Heliox inhalation. Such studies would provide the necessary information as to the appropriate place for Heliox in the therapeutic schedule for severe bronchiolitis
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Heliox inhalation therapy for bronchiolitis in infants.
The Cochrane database of systematic reviews, 2015Co-Authors: Jean-michel Liet, Vineet Gupta, Thierry Ducruet, Gilles CambonieAbstract:Bronchiolitis is the leading cause of hospitalisation among infants in high-income countries. Acute viral bronchiolitis is associated with airway obstruction and turbulent gas flow. Heliox, a mixture of oxygen and the inert gas helium, may improve gas flow through high-resistance airways and decrease the work of breathing. In this review, we selected trials that objectively assessed the effect of the addition of Heliox to standard medical care for acute bronchiolitis. To assess Heliox inhalation therapy in addition to standard medical care for acute bronchiolitis in infants with respiratory distress, as measured by clinical endpoints (in particular the rate of endotracheal intubation, the rate of emergency department discharge, the length of treatment for respiratory distress) and pulmonary function testing (mainly clinical respiratory scores). We searched CENTRAL (2015, Issue 2), MEDLINE (1966 to March week 3, 2015), EMBASE (1974 to March 2015), LILACS (1982 to March 2015) and the National Institutes of Health (NIH) website (May 2009). Randomised controlled trials (RCTs) and quasi-RCTs of Heliox in infants with acute bronchiolitis. Two review authors independently extracted data and assessed trial quality. We included seven trials involving 447 infants younger than two years with respiratory distress secondary to viral bronchiolitis. All children were recruited from a paediatric intensive care unit (PICU; 378 infants), except in one trial (emergency department; 69 infants). All children were younger than two (under nine months in two trials and under three months in one trial). Positive tests for respiratory syncytial virus (RSV) were required for inclusion in five trials. The two other trials were carried out in the bronchiolitis seasons. Seven different protocols were used for inhalation therapy with Heliox.When Heliox was used in the PICU, we observed no significant reduction in the rate of intubation: risk ratio (RR) 2.73 (95% confidence interval (CI) 0.96 to 7.75, four trials, 408 infants, low quality evidence). When Heliox inhalation was used in the emergency department, we observed no increase in the rate of discharge: RR 0.51 (95% CI 0.17 to 1.55, one trial, 69 infants, moderate quality evidence).There was no decrease in the length of treatment for respiratory distress: mean difference (MD) -0.19 days (95% CI -0.56 to 0.19, two trials, 320 infants, moderate quality evidence). However, in the subgroup of infants who were started on nasal continuous positive airway pressure (nCPAP) right from the start, because of severe respiratory distress, Heliox therapy reduced the length of treatment: MD -0.76 days (95% CI -1.45 to -0.08, one trial, 21 infants, low quality evidence). No adverse events related to Heliox inhalation were reported.We found that infants treated with Heliox inhalation had a significantly lower mean clinical respiratory score in the first hour after starting treatment when compared to those treated with air or oxygen inhalation: MD -1.04 (95% CI -1.60 to -0.48, four trials, 138 infants, moderate quality evidence). This outcome had statistical heterogeneity, which remained even after removing the study using a standard high-concentration reservoir mask. Several factors may explain this heterogeneity, including first the limited number of patients in each trial, and the wide differences in the baseline severity of disease between studies, with the modified Wood Clinical Asthma Score (m-WCAS) in infants treated with Heliox ranging from less than two to more than seven. Current evidence suggests that the addition of Heliox therapy may significantly reduce a clinical score evaluating respiratory distress in the first hour after starting treatment in infants with acute RSV bronchiolitis. We noticed this beneficial effect regardless of which Heliox inhalation protocol was used. Nevertheless, there was no reduction in the rate of intubation, in the rate of emergency department discharge, or in the length of treatment for respiratory distress. Heliox could reduce the length of treatment in infants requiring CPAP for severe respiratory distress. Further studies with homogeneous logistics in their Heliox application are needed. Inclusion criteria must include a clinical severity score that reflects severe respiratory distress to avoid inclusion of children with mild bronchiolitis who may not benefit from Heliox inhalation. Such studies would provide the necessary information as to the appropriate place for Heliox in the therapeutic schedule for severe bronchiolitis.
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The Cochrane Library - Heliox inhalation therapy for bronchiolitis in infants
The Cochrane database of systematic reviews, 2010Co-Authors: Jean-michel Liet, Vineet Gupta, Thierry Ducruet, Gilles CambonieAbstract:Background Bronchiolitis is the leading cause of hospitalisation among infants in high-income countries. Acute viral bronchiolitis is associated with airway obstruction and turbulent gas flow. Heliox, a mixture of oxygen and the inert gas helium, may improve gas flow through high-resistance airways and decrease the work of breathing. In this review, we selected trials that objectively assessed the effect of the addition of Heliox to standard medical care for acute bronchiolitis. Objectives To assess Heliox inhalation therapy in addition to standard medical care for acute bronchiolitis in infants with respiratory distress, as measured by clinical endpoints (in particular the rate of endotracheal intubation, the rate of emergency department discharge, the length of treatment for respiratory distress) and pulmonary function testing (mainly clinical respiratory scores). Search methods We searched CENTRAL (2015, Issue 2), MEDLINE (1966 to March week 3, 2015), EMBASE (1974 to March 2015), LILACS (1982 to March 2015) and the National Institutes of Health (NIH) website (May 2009). Selection criteria Randomised controlled trials (RCTs) and quasi-RCTs of Heliox in infants with acute bronchiolitis. Data collection and analysis Two review authors independently extracted data and assessed trial quality. Main results We included seven trials involving 447 infants younger than two years with respiratory distress secondary to viral bronchiolitis. All children were recruited from a paediatric intensive care unit (PICU; 378 infants), except in one trial (emergency department; 69 infants). All children were younger than two (under nine months in two trials and under three months in one trial). Positive tests for respiratory syncytial virus (RSV) were required for inclusion in five trials. The two other trials were carried out in the bronchiolitis seasons. Seven different protocols were used for inhalation therapy with Heliox. When Heliox was used in the PICU, we observed no significant reduction in the rate of intubation: risk ratio (RR) 2.73 (95% confidence interval (CI) 0.96 to 7.75, four trials, 408 infants, low quality evidence). When Heliox inhalation was used in the emergency department, we observed no increase in the rate of discharge: RR 0.51 (95% CI 0.17 to 1.55, one trial, 69 infants, moderate quality evidence). There was no decrease in the length of treatment for respiratory distress: mean difference (MD) -0.19 days (95% CI -0.56 to 0.19, two trials, 320 infants, moderate quality evidence). However, in the subgroup of infants who were started on nasal continuous positive airway pressure (nCPAP) right from the start, because of severe respiratory distress, Heliox therapy reduced the length of treatment: MD -0.76 days (95% CI -1.45 to -0.08, one trial, 21 infants, low quality evidence). No adverse events related to Heliox inhalation were reported. We found that infants treated with Heliox inhalation had a significantly lower mean clinical respiratory score in the first hour after starting treatment when compared to those treated with air or oxygen inhalation: MD -1.04 (95% CI -1.60 to -0.48, four trials, 138 infants, moderate quality evidence). This outcome had statistical heterogeneity, which remained even after removing the study using a standard high-concentration reservoir mask. Several factors may explain this heterogeneity, including first the limited number of patients in each trial, and the wide differences in the baseline severity of disease between studies, with the modified Wood Clinical Asthma Score (m-WCAS) in infants treated with Heliox ranging from less than two to more than seven. Authors' conclusions Current evidence suggests that the addition of Heliox therapy may significantly reduce a clinical score evaluating respiratory distress in the first hour after starting treatment in infants with acute RSV bronchiolitis. We noticed this beneficial effect regardless of which Heliox inhalation protocol was used. Nevertheless, there was no reduction in the rate of intubation, in the rate of emergency department discharge, or in the length of treatment for respiratory distress. Heliox could reduce the length of treatment in infants requiring CPAP for severe respiratory distress. Further studies with homogeneous logistics in their Heliox application are needed. Inclusion criteria must include a clinical severity score that reflects severe respiratory distress to avoid inclusion of children with mild bronchiolitis who may not benefit from Heliox inhalation. Such studies would provide the necessary information as to the appropriate place for Heliox in the therapeutic schedule for severe bronchiolitis.