Am. J. Respir. Crit. Care Med., Volume 161, Number 4, April 2000, 1191-1200

Noninvasive Ventilation with Helium-Oxygen in Acute Exacerbations of Chronic Obstructive Pulmonary Disease

SAMIR JABER, REDOUANE FODIL, ANNALISA CARLUCCI, MOHAMED BOUSSARSAR, JÉRÔME PIGEOT, FRANÇOIS LEMAIRE, ALAIN HARF, FRÉDÉRIC LOFASO, DANIEL ISABEY, and LAURENT BROCHARD

Service de Réanimation Médicale, Hôpital Henri Mondor, AP-HP, Université Paris 12 et INSERM U492, Créteil, France

The use of helium-oxygen (HeO₂) was tested in combination with noninvasive ventilation (NIV) in 10 patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Effort to breathe as assessed by the respiratory muscle pressure-time index (PTI), work of breathing (WOB), and gas exchange were the main endpoints. Results of NIV-HeO₂ were compared with those obtained with standard NIV (AirO₂), at two levels of pressure-support ventilation (PSV), 9 ± 2 cm H₂O and 18 ± 3 cm H₂O. Significant reductions in PTI were observed between HeO₂ and AirO₂ at both the low PSV level (n = 9; 160 ± 58 versus 198 ± 78 cm H₂O/s/ min; p < 0.05) and the high PSV level (n = 10; 100 ± 45 versus 150 ± 82 cm H₂O/s/min; p < 0.01). WOB also differed significantly between HeO₂ and AirO₂ (7.8 ± 4.1 versus 10.9 ± 6.1 J/min at the low PSV level, p < 0.05; and 5.7 ± 3.3 versus 9.2 ± 5. J/min, p < 0.01 at the high PSV level). HeO₂ reduced Pa_CO2 at both the low PSV level (61 ± 13 versus 64 ± 15 mm Hg; p < 0.05) and the high PSV level (56 ± 13 versus 58 ± 14 mm Hg; p < 0.05), without significantly changing breathing pattern or oxygenation. We conclude that use of HeO₂ during NIV markedly enhances the ability of NIV to reduce patient effort and to improve gas exchange.

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