Mechanical Ventilation During Pregnancy Using a Helium–Oxygen Mixture in a Patient With Respiratory Failure due to Status Asthmaticus

George, Reggie; Berkenbosch, John W.; Fraser, Robert F.; Tobias, Joseph D.

doi:10.1038/sj.jp.7210530

Cited by 26 publications

(12 citation statements)

References 18 publications

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“…Heliox allowed for a reduction in minute volume ventilation, while CO 2 removal remained unaltered. These effects are in line with findings in pediatric ARDS models [12,13,14], as well as in pediatric and adult patients with respiratory failure due to exacerbation of COPD or asthma [9,10,18,19,20]. In ARDS models, heliox has mostly been studied as a driving gas during HFOV.…”

Section: Discussionsupporting

confidence: 78%

Heliox Allows for Lower Minute Volume Ventilation in an Animal Model of Ventilator-Induced Lung Injury

et al. 2013

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BackgroundHelium is a noble gas with a low density, allowing for lower driving pressures and increased carbon dioxide (CO2) diffusion. Since application of protective ventilation can be limited by the development of hypoxemia or acidosis, we hypothesized that therefore heliox facilitates ventilation in an animal model of ventilator–induced lung injury.MethodsSprague-Dawley rats (N=8 per group) were mechanically ventilated with heliox (50% oxygen; 50% helium). Controls received a standard gas mixture (50% oxygen; 50% air). VILI was induced by application of tidal volumes of 15 mL kg-1; lung protective ventilated animals were ventilated with 6 mL kg-1. Respiratory parameters were monitored with a pneumotach system. Respiratory rate was adjusted to maintain arterial pCO2 within 4.5-5.5 kPa, according to hourly drawn arterial blood gases. After 4 hours, bronchoalveolar lavage fluid (BALF) was obtained. Data are mean (SD).ResultsVILI resulted in an increase in BALF protein compared to low tidal ventilation (629 (324) vs. 290 (181) μg mL-1; p<0.05) and IL-6 levels (640 (8.7) vs. 206 (8.7) pg mL-1; p<0.05), whereas cell counts did not differ between groups after this short course of mechanical ventilation. Ventilation with heliox resulted in a decrease in mean respiratory minute volume ventilation compared to control (123±0.6 vs. 146±8.9 mL min-1, P<0.001), due to a decrease in respiratory rate (22 (0.4) vs. 25 (2.1) breaths per minute; p<0.05), while pCO2 levels and tidal volumes remained unchanged, according to protocol. There was no effect of heliox on inspiratory pressure, while compliance was reduced. In this mild lung injury model, heliox did not exert anti-inflammatory effects.ConclusionsHeliox allowed for a reduction in respiratory rate and respiratory minute volume during VILI, while maintaining normal acid-base balance. Use of heliox may be a useful approach when protective tidal volume ventilation is limited by the development of severe acidosis.

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Section: Discussionsupporting

confidence: 78%

Heliox Allows for Lower Minute Volume Ventilation in an Animal Model of Ventilator-Induced Lung Injury

et al. 2013

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“…In paediatric patients, the frequency of complications was described, without any appreciable effect of heliox ventilation [34]. Another case report describes that heliox ventilation was safe during pregnancy [56]. It is of note, however, that the safety of heliox in various modes of ventilation has not been studied systematically.…”

Section: Resultsmentioning

confidence: 99%

The Potential of Heliox as a Therapy for Acute Respiratory Distress Syndrome in Adults and Children: A Descriptive Review

et al. 2015

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Background: In neonatal respiratory distress syndrome (RDS) and acute RDS (ARDS) mechanical ventilation is often necessary to manage hypoxia, whilst protecting the lungs through lower volume ventilation and permissive hypercapnia. Mechanical ventilation can, however, induce or aggravate the lung injury caused by the respiratory distress. Helium, in a gas mixture with oxygen (heliox), has a low density and can reduce the flow in narrow airways and allow for lower driving pressures. Objectives: The aim of this study was to review preclinical and clinical studies of the use of heliox ventilation in acute lung injury associated with respiratory failure. Methods: A systematic search was executed in the PubMed and EMBASE databases, with search terms referring to ARDS or an acute lung injury condition associated with respiratory failure and the corresponding intervention. Results: A total of 576 papers were retrieved. After the majority had been excluded 20 papers remained, of which 6 articles described animal models (3 paediatric; 3 adult animal models) and 14 were clinical studies, of which 12 described paediatric patient populations and 2 adult patient populations. In both paediatric and adult animal models, heliox improved gas exchange while allowing for less invasive ventilation in a wide variety of models using different ventilation modes. Clinical studies show a reduction in the work of breathing during heliox ventilation, with a concomitant increase in pH and decrease in PaCO₂ levels compared to oxygen ventilation. Conclusions: Although evidence so far is limited, there may be a rationale for heliox ventilation in ARDS as an intervention to improve ventilation and reduce the work of breathing.

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“…Although the use of helium-oxygen mixtures might be attempted as helium reduces airway resistance due to its low density, little evidence actually support this strategy. 18,33 Theoretically, extracorporeal gas exchange would be the best option in this situation, but only anecdotal experience has been reported. In this situation, emergency extraction of the fetus should be considered.…”

Section: Hypercapniamentioning

confidence: 97%

Breathing for Two

Mendoza-Asensi¹

2009

Clinical Pulmonary Medicine

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The respiratory and cardiovascular physiological changes experienced by women during pregnancy affect their ability to tolerate pulmonary disease and require significant adjustments in their evaluation and management. Most respiratory disorders needing mechanical ventilation are obstetric diseases, such as pre-eclampsia and eclampsia, amniotic fluid embolism, or peripartum cardiomyopathy, whereas others are medical conditions brought on by the altered physiology of pregnancy, such as thromboembolic disease, pulmonary edema, or aspiration pneumonia.In a pregnant patient in respiratory failure or receiving mechanical ventilation, gas exchange goals might have to be different from those in the nonpregnant population because optimal oxygen delivery to the fetus must be ensured and fetal acidosis avoided. Indications for mechanical ventilation are similar to those established for the general population, but the physician's tolerance of maternal hypoxemia and hypercapnia must be lower. Despite the lack of studies including pregnant population, protective ventilation can be assumed to be the standard ventilatory strategy given its proven survival benefit in the general population. However, permissive hypercapnia, often necessary to maintain low tidal volumes, might not be a safe option for the fetus. Avoiding hypercapnia is therefore a major challenge when ventilating a pregnant patient.Extraction of the fetus may improve the maternal condition, but it must be reserved for refractory cases unless there is evidence of fetal distress. Fetal monitoring is recommended if the maternal condition changes, whereas plans for the fetus must be made by the treating physicians at admission.

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Mechanical Ventilation During Pregnancy Using a Helium–Oxygen Mixture in a Patient With Respiratory Failure due to Status Asthmaticus

Cited by 26 publications

References 18 publications

Heliox Allows for Lower Minute Volume Ventilation in an Animal Model of Ventilator-Induced Lung Injury

Heliox Allows for Lower Minute Volume Ventilation in an Animal Model of Ventilator-Induced Lung Injury

The Potential of Heliox as a Therapy for Acute Respiratory Distress Syndrome in Adults and Children: A Descriptive Review

Breathing for Two

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