heliox for acute asthma

19 Dec
–10 small RCT’s (7 adults, 3 children), 544 acute asthma patients comparing inhaled heliox vs placebo (O2, air) in addition to standard treatment found no difference in PFT’s or admission to hospital (1)
–However, in subgroup of patients with severe baseline pulmonary function, heliox did improve PFT so may be some benefit to use in patients w/severe airway obstruction
–Should be considered after 1st (albuterol, Duoneb, steroid) and 2nd (mag, terbutaline, epi) line therapies fail and patient still has some reserve
–“Heliox-driven albuterol nebulization may be considered for patients who have life- threatening exacerbation or who remain in severe exacerbation after intensive conventional adjunctive therapy” (2)
–Since generally given in mixtures of 70:30 (helium:O2) CANNOT use in patients who are hypoxemic (i.e. need 50% FiO2)
–If the patient needs to be intubated, INTUBATE!
Submitted by F. DiFranco.
Reference(s): (1) i.Rodrigo GJ, Pollack CV, Rodrigo C, Rowe BH. Heliox for non-intubated acute asthma patients. Cochrane Database of Systematic Reviews 2006, Issue 4; (2) Cincinnati Children’s Hospital Medical Center. Evidence-based care guideline for management of acute asthma exacerbation in children. Cincinnati (OH): Cincinnati Children’s Hospital Medical Center; INFO@GUIDELINES.GOV 2011, picture

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