Use of Heliox Delivered via High-Flow Nasal Cannula to Treat an Infant With Coronavirus-Related Respiratory Infection and Severe Acute Air-Flow Obstruction

Abstract

Heliox, a helium-oxygen gas mixture, has been used for many decades to treat obstructive pulmonary disease. The lower density and higher viscosity of heliox relative to nitrogen-oxygen mixtures can significantly reduce airway resistance when an anatomic upper air-flow obstruction is present and gas flow is turbulent. Clinically, heliox can decrease airway resistance in acute asthma in adults and children and in COPD. Heliox may also enhance the bronchodilating effects of ␤-agonist administration for acute asthma. Respiratory syndromes caused by coronavirus infections in humans range in severity from the common cold to severe acute respiratory syndrome associated with human coronavirus OC43 and other viral strains. In infants, coronavirus infection can cause bronchitis, bronchiolitis, and pneumonia in variable combinations and can produce enough air-flow obstruction to cause respiratory failure. We describe a case of coronavirus OC43 infection in an infant with severe acute respiratory distress treated with heliox inhalation to avoid intubation.

High-Flow Nasal Cannula and Aerosolized β Agonists for Rescue Therapy in Children With Bronchiolitis: A Case Series

“…These infections range in severity from mild respiratory infections (common cold) to severe respiratory distress syndromes and can produce enough air-flow obstruction to cause respiratory failure. 1,2 Clinically, both asthma and bronchiolitis result in the acute onset of respiratory distress, during which patients frequently present to the clinic or pediatric emergency department for urgent care.…”

Impact of Helium-Oxygen Administered via High Velocity Nasal Insufflation on Delivery of Inhaled Nitric Oxide

“…Helium-oxygen gas mixtures have been utilized successfully in the management of postextubation stridor, bronchiolitis, and status asthmaticus 8 and can be delivered successfully via HFNC. 9,10 Thus, it can be expected that there may be clinical situations where patients receiving iNO noninvasively may be considered for treatment with inhaled helium-oxygen mixtures concurrently.…”

“…6,7 Lower airway obstruction may occur in conditions common to children, such as asthma and bronchiolitis. [8][9][10] Administration of helium-oxygen gas mixtures is one approach to the management of upper and lower airway obstruction. Helium-oxygen gas mixtures were successfully administered using HFNC and HiVNi.…”

“…Helium-oxygen gas mixtures were successfully administered using HFNC and HiVNi. 9,10 Upper and lower airway obstruction may occur in children who require noninvasive administration of iNO, such that the coadministration of helium-oxygen gas mixtures might be Keywords ► inhaled nitric oxide ► high flow nasal cannula ► high velocity nasal insufflation…”

Helium-oxygen mixture: clinical applicability in an intensive care unit

“…Recent studies have demonstrated that the use of Heliox ® with a high-flow nasal cannula had a significant influence on the improvement of oxygenation and respiratory rate, and can be a successful alternative in the future, since it demands more accessible equipment than the microprocessed ventilators used in noninvasive mechanical ventilation. ( 31 , 32 )…”