Am. J. Respir. Crit. Care Med., Volume 164, Number 4, August 2001, 633-637

Helium-Oxygen in the Postextubation Period Decreases Inspiratory Effort

SAMIR JABER, ANNALISA CARLUCCI, MOHAMED BOUSSARSAR, REDOUANE FODIL, JÉRÔME PIGEOT, SALVATORE MAGGIORE, ALAIN HARF, DANIEL ISABEY, and LAURENT BROCHARD

Service de Réanimation Médicale, Hôpital Henri Mondor, AP-HP, Université Paris ¹ 2 and INSERM U492, Créteil, France

After tracheal extubation, upper and total airway resistances may frequently be increased resulting in an increase in inspiratory effort to breathe. We tested whether breathing a helium-oxygen mixture (HeO₂) would reduce inspiratory effort in the period after extubation. Eighteen consecutive patients with no chronic obstructive pulmonary disease who had received mechanical ventilation (> 48 h) were successively studied immediately after extubation (N₂O₂), 15 min after breathing HeO₂, and after return to N₂O₂. Effort to breathe, assessed by the transdiaphragmatic pressure swings (Pdi) and the pressure-time index of the diaphragm (PTI), comfort, and gas exchange, were the main end points. The mean reduction of the transdiaphragmatic pressure under HeO₂ was 19 ± 5%. All but three patients presented a decrease in transdiaphragmatic pressure under HeO₂, ranging from  4 to  55%, and a significant reduction in Pdi was observed between HeO₂ and N₂O₂ (10.2 ± 0.7 versus 8.6 ± 1.1 versus 10.0 ± 0.8 cm H₂O for the three consecutive periods; p < 0.05). PTI also differed significantly between HeO₂ and N₂O₂ (197 ± 19 versus 166 ± 22 versus 201 ± 23 cm H₂O/s/min for the three periods; p < 0.05). Breathing HeO₂ significantly improved comfort, whereas gas exchange was not modified. We conclude that the use of HeO₂ in the immediate postextubation period decreases inspiratory effort and improves comfort.

Keywords: Helium-oxygen; exutbation; weaning; work of breathing

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