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1 From the Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cooper Hospital/University Medical Center, UMDNJ/Robert Wood Johnson School of Medicine at Camden, Camden, NJ, and the Pulmonary Section, Department of Medicine, Mount Sinai Hospital, University of Connecticut School of Medicine, Hartford
Study objective: To assess how patients with respiratory acidosis from acute severe asthma respond to helium-oxygen (heliox) mixtures.
Design: Consecutive case series.
Setting: Urban community teaching hospital.
Patients: Over a 2-year period, 12 asthmatics (mean age, 33.8±11.3 years) presented to the emergency department with acute respiratory acidosis (pH <7.35 and PaCO2
45 mm Hg). All 12 patients were treated with heliox (60 to 70% helium/30 to 40% oxygen). Five patients received heliox through a ventilator and seven received heliox via face mask.
Results: Arterial blood gases (ABGs) were drawn immediately before and at a mean of 49.2±25.2 min after beginning heliox therapy. No therapeutic interventions were made between ABGs. For the entire group, the mean PaCO2 decreased from 57.9 to 47.5 mm Hg (p<0.005) and the arterial pH increased from 7.23 to 7.32 (p<0.001). In an attempt to find characteristics that might predict the response to heliox, a clinically significant response to heliox was defined as a drop in PaCO2 (to normal or by 15%) coupled with a rise in pH by 0.05. Using this definition, there were eight responders (67%) and four nonresponders (33%). The responders had a shorter duration of symptoms (17.8 vs 78.0 h, p<0.05) and a lower preheliox pH (7.20 vs 7.30, p<0.05). All of the responders presented within 24 h of symptom onset. Three of the four nonresponders reported prolonged (96 h) duration of symptoms, and two eventually required intubation.
Conclusion: Heliox can rapidly improve ventilation in patients presenting to an emergency department with acute severe asthma with respiratory acidosis and a short duration of symptoms.
Key Words: asthma • heliox • helium • respiratory acidosis • status asthmaticus
Submitted on April 4, 1994
Accepted on October 25, 2007
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