Allergy and Airway |

Therapeutic Utility of Heliox in the Medical Intensive Care Unit and Outcomes FREE TO VIEW

G Zacharia Reagle, DO; Reza Ronaghi, MD; Christopher Russo, DO; Wade Veneman, RT; Vijay Balasubramanian, MD
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UCSF Fresno, Fresno, CA

Chest. 2013;144(4_MeetingAbstracts):65A. doi:10.1378/chest.1703669
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SESSION TITLE: Airway Management Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Heliox - Helium-oxygen mixture, has been used since the 1930s, to alleviate symptoms of upper airway obstruction. Therapeutic efficacy data mainly stems from pediatric literature. There is relative paucity of data pertaining to its efficacy in Adults. We report our experience with Heliox used for the management of upper airway obstruction and post-extubation stridor in adults at our institution.

METHODS: A retrospective analysis of adult cases of post-extubation stridor (PES) and stridor attributed to primary upper airway obstruction (UAO) managed with Heliox in our institution from January 2011 through December 2012.

RESULTS: 28 patients were identified from medical records who received Heliox. Upper airway obstruction was the main indication in all of these patients. 15 had primary UAO and 13 had PES. In the UAO subgroup, 6 patients (40%) were eventually intubated. Of those 6, 5 (83%) had a tumor mass causing upper airway obstruction, 2 underwent tracheostomy, and 4 were eventually extubated. The mean duration of treatment with Heliox was 20.2 hours. Nine of the 15 (60%) did not require intubation. Their mean duration of Heliox was 16.7 hours. In the PES subgroup, 4 (31%) required re-intubation and 9 (69%) stayed extubated. The mean time from extubation to initiation of Heliox was 247 minutes for patients who did not require re-intubation versus 500 minutes for patients who did require re-intubation (statistically insignificant difference with a p-value of 0.28). The mean duration of Heliox therapy for patients who required re-intubation was 23.25 hours compared to 21.3 hours for patients who did not.

CONCLUSIONS: 1. Heliox administration may be a simple and efficacious adjunctive therapy in management of acute respiratory failure secondary to upper airway obstruction in adults. 2. A prospective study is needed to further validate the therapeutic efficacy of Heliox in Adults.

CLINICAL IMPLICATIONS: 1. Earlier initiation of Heliox may predispose to improved outcomes. 2. Heliox may be considered in patients with UAO due to non-neoplastic etiology

DISCLOSURE: The following authors have nothing to disclose: G Zacharia Reagle, Reza Ronaghi, Christopher Russo, Wade Veneman, Vijay Balasubramanian

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