heliox for acute asthma

COCHRANE REVIEW:

--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

PEARLS:

--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