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Correspondence

Indian Pediatr 2015;52: 255

Heliox Use in Ventilation of Preterms


Abdul Razak

Manipal Hospital, Bengaluru, Karnataka, India.
Email: razakmdpaed@gmail.com
 

   


The recent randomized controlled trial by Xue, et al. [1] aims at reducing the length of ventilation as primary aim. The authors have also looked into lung inflammatory markers like Interleukin-6, which was positively correlated with the length of ventilation but was not proved significant.

Heliox gas flows in laminar fashion creating less resistance because of its property of low density and lower Reynolds number which thereby helps in gas exchange and reduced work of breathing, particularly in disease states where there is evidence of airway obstruction [2,3]. It is still unclear how heliox helps in improving outcome in respiratory distress syndrome; the possible explanation other than reducing lung inflammation is improving oxygenation and carbon dioxide elimination and thereby improving the blood pH and reducing pulmonary hypertension.

The participants in this study were mid-late premature infants (mean gestation 34 weeks); many ongoing/completed trials aim to assess interventions for reducing morbidity, particularly chronic lung disease, in preterm cohorts born earlier than 34 weeks. Reduction in length of ventilation in this study cohort may not be too great as these babies generally require short term ventilation. Moreover, heliox is likely to be a costly intervention; the reported cost is 750 for 12 hours of treatment [4].

The authors have concluded that nasal intermittent positive pressure ventilation might have increased the efficacy of delivering heliox, as an earlier study [4] failed to show reduction in length of ventilation when CPAP was used. The population in the earlier trial was more premature (30 weeks) and the reduction in the length of ventilation was not the primary objective. Practically, heliox reduces the increasing oxygen requirement by effective delivery of gas thereby decreasing the threshold for surfactant/ventilation and is unlikely to affect the length of ventilation. We suggest that the utility of heliox should be tested in more immature infants with the objective to reduce chronic lung disease and other morbidity.

References

1. Li X, Shen J, Zhao J, Tang S, Shi Y. Nasal intermittent positive pressure ventilation with heliox in premature infants with respiratory distress syndrome: A randomized controlled trial. Indian Pediatr. 2014;51: 900-2.

2. Myers TR. Use of heliox in children. Respir Care. 2006;51:619-31.

3. Gupta VK, Cheifetz IM. Heliox administration in the pediatric intensive care unit: An evidence-based review. Pediatr Crit Care Med. 2005;6:204-11.

4. Colnaghi M, Pierro M, Migliori C, Ciralli F, Matassa PG, Vendettuoli V, et al. Nasal continuous positive airway pressure with heliox in preterm infants with respiratory distress syndrome. Pediatrics. 2012;129:e333-8.


 

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