CA Manthous, JB Hall, MA Caputo, J Walter, JM Klocksieben, GA Schmidt and LD Wood
Section of Pulmonary and Critical Care Medicine, University of Chicago, Illinois.

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)

This article has been cited by other articles:

				S. Aldington and R. Beasley Asthma exacerbations {middle dot} 5: Assessment and management of severe asthma in adults in hospital Thorax, May 1, 2007; 62(5): 447 - 458. [Abstract] [Full Text] [PDF]

				S. Dhuper, S. Choksi, S. Selvaraj, G. Jha, A. Ahmed, H. Babbar, B. Walia, A. Chandra, V. Chung, and C. Shim Room Air Entrainment During {beta}-Agonist Delivery With Heliox. Chest, October 1, 2006; 130(4): 1063 - 1071. [Abstract] [Full Text] [PDF]

				J. Rayner, F. Trespalacios, J. Machan, V. Potluri, G. Brown, L. M. Quattrucci, and G. D. Jay Continuous noninvasive measurement of pulsus paradoxus complements medical decision making in assessment of acute asthma severity. Chest, September 1, 2006; 130(3): 754 - 765. [Abstract] [Full Text] [PDF]

				D. M. Schreck Asthma pathophysiology and evidence-based treatment of severe exacerbations. Am. J. Health Syst. Pharm., May 15, 2006; 63(10 Suppl 3): S5 - 13. [Abstract] [Full Text] [PDF]

				I. K. Kim, E. Phrampus, S. Venkataraman, R. Pitetti, A. Saville, T. Corcoran, E. Gracely, N. Funt, and A. Thompson Helium/Oxygen-Driven Albuterol Nebulization in the Treatment of Children With Moderate to Severe Asthma Exacerbations: A Randomized, Controlled Trial Pediatrics, November 1, 2005; 116(5): 1127 - 1133. [Abstract] [Full Text] [PDF]

				J. W. Berkenbosch, R. E. Grueber, G. R. Graff, and J. D. Tobias Patterns of Helium-Oxygen (Heliox) Usage in the Critical Care Environment J Intensive Care Med, November 1, 2004; 19(6): 335 - 344. [Abstract] [PDF]

				G. J. Rodrigo, C. Rodrigo, and J. B. Hall Acute Asthma in Adults: A Review Chest, March 1, 2004; 125(3): 1081 - 1102. [Abstract] [Full Text] [PDF]

				A D Reuben and A R Harris Heliox for asthma in the emergency department: a review of the literature Emerg. Med. J., March 1, 2004; 21(2): 131 - 135. [Abstract] [Full Text] [PDF]

				E. R. McFadden Jr. Acute Severe Asthma Am. J. Respir. Crit. Care Med., October 1, 2003; 168(7): 740 - 759. [Abstract] [Full Text] [PDF]

				J. E. Kass Heliox Redux Chest, March 1, 2003; 123(3): 673 - 676. [Full Text] [PDF]

				C. A. Manthous Heliox for Status Asthmaticus? Chest, March 1, 2003; 123(3): 676 - 677. [Full Text] [PDF]

				A. M.-H. Ho, A. Lee, M. K. Karmakar, P. W. Dion, D. C. Chung, and L. H. Contardi Heliox vs Air-Oxygen Mixtures for the Treatment of Patients With Acute Asthma: A Systematic Overview Chest, March 1, 2003; 123(3): 882 - 890. [Abstract] [Full Text] [PDF]

				G. J. Rodrigo, C. Rodrigo, C. V. Pollack, and B. Rowe Use of Helium-Oxygen Mixtures in the Treatment of Acute Asthma: A Systematic Review Chest, March 1, 2003; 123(3): 891 - 896. [Abstract] [Full Text] [PDF]

				J. M. Haynes, R. J. Sargent, and E. L. Sweeney Use of Heliox to Avoid Intubation in a Child With Acute Severe Asthma and Hypercapnia Am. J. Crit. Care., January 1, 2003; 12(1): 28 - 30. [Full Text] [PDF]

				J. E. Johnson, D. J. Gavin, and S. Adams-Dramiga Effects of Training With Heliox and Noninvasive Positive Pressure Ventilation on Exercise Ability in Patients With Severe COPD* Chest, August 1, 2002; 122(2): 464 - 472. [Abstract] [Full Text] [PDF]

				J. P. Kress, I. Noth, B. K. Gehlbach, N. Barman, A. S. Pohlman, A. Miller, S. Morgan, and J. B. Hall The Utility of Albuterol Nebulized with Heliox during Acute Asthma Exacerbations Am. J. Respir. Crit. Care Med., May 1, 2002; 165(9): 1317 - 1321. [Abstract] [Full Text] [PDF]

				M. FitzGerald Extracts from ""Clinical Evidence"": Acute asthma BMJ, October 13, 2001; 323(7317): 841 - 845. [Full Text] [PDF]

				S. JABER, A. CARLUCCI, M. BOUSSARSAR, R. FODIL, J. PIGEOT, S. MAGGIORE, A. HARF, D. ISABEY, and L. BROCHARD Helium-Oxygen in the Postextubation Period Decreases Inspiratory Effort Am. J. Respir. Crit. Care Med., August 15, 2001; 164(4): 633 - 637. [Abstract] [Full Text] [PDF]

				A. Oppenheim-Eden, Y. Cohen, C. Weissman, and R. Pizov The Effect of Helium on Ventilator Performance : Study of Five Ventilators and a Bedside Pitot Tube Spirometer Chest, August 1, 2001; 120(2): 582 - 588. [Abstract] [Full Text] [PDF]

				J. Barr, G. Eshel, Z. Chen-Levy, and E. Lahat Heliox Use in the Treatment of Acute Hyperammonemia J Child Neurol, June 1, 2001; 16(6): 456 - 458. [Abstract] [PDF]

				M. Nie, H. Kobayashi, M. Sugawara, T. Tomita, K. Ohara, and H. Yoshimura Helium inhalation enhances vasodilator effect of inhaled nitric oxide on pulmonary vessels in hypoxic dogs Am J Physiol Heart Circ Physiol, April 1, 2001; 280(4): H1875 - H1881. [Abstract] [Full Text] [PDF]

				M. L. GOODE, J. B. FINK, R. DHAND, and M. J. TOBIN Improvement in Aerosol Delivery with Helium-Oxygen Mixtures during Mechanical Ventilation Am. J. Respir. Crit. Care Med., January 1, 2001; 163(1): 109 - 114. [Abstract] [Full Text]

				S. JABER, R. FODIL, A. CARLUCCI, M. BOUSSARSAR, J. PIGEOT, F. LEMAIRE, A. HARF, F. LOFASO, D. ISABEY, and L. BROCHARD Noninvasive Ventilation with Helium-Oxygen in Acute Exacerbations of Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., April 1, 2000; 161(4): 1191 - 1200. [Abstract] [Full Text]

				C. E. R. Carter and J. E. Kass Heliox for Acute Severe Asthma Chest, April 1, 2000; 117(4): 1212 - 1213. [Full Text] [PDF]

				J. E. Kass and C. A. Terregino The Effect of Heliox in Acute Severe Asthma: A Randomized Controlled Trial Chest, August 1, 1999; 116(2): 296 - 300. [Abstract] [Full Text] [PDF]

				M. A. Jantz and N. A. Collop Bronchodilator Aerosol Delivery in Mechanical Ventilation: Jantz MA, Collop NA Bronchodilator Aerosol Delivery in Mechanical Ventilation Intensive Care Med 1999,14 166-183 J Intensive Care Med, July 1, 1999; 14(4): 166 - 183. [PDF]

				D. R. Hess, F. L. Acosta, R. H. Ritz, R. M. Kacmarek, and C. A. Camargo Jr The Effect of Heliox on Nebulizer Function Using a {beta}-Agonist Bronchodilator Chest, January 1, 1999; 115(1): 184 - 189. [Abstract] [Full Text] [PDF]

				J. A. Everett Alternatives to Standard Status Asthmaticus Therapy Journal of Pharmacy Practice, June 1, 1997; 10(3): 186 - 199. [Abstract] [PDF]

				D. W. STEELE, K. A. SANTUCCI, R. O. WRIGHT, R. NATARAJAN, K. K. MCQUILLEN, and G. D. JAY Pulsus Paradoxus . An Objective Measure of Severity in Croup Am. J. Respir. Crit. Care Med., January 1, 1997; 157(1): 331 - 334. [Abstract] [Full Text]