Published online November 1, 2005
PEDIATRICS Vol. 116 No. 5 November 2005, pp. 1127-1133 (doi:10.1542/peds.2004-2136)
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Helium/Oxygen-Driven Albuterol Nebulization in the Treatment of Children With Moderate to Severe Asthma Exacerbations: A Randomized, Controlled Trial

In K. Kim, MD*, Erin Phrampus, MD, MPH*, Shekhar Venkataraman, MD{ddagger}, Raymond Pitetti, MD, MPH*, Al Saville, RRT{ddagger}, Timothy Corcoran, PhD§, Ed Gracely, PhD||, Nicole Funt, MPAS, PA-C* and Ann Thompson, MD{ddagger}

* Divisions of Pediatric Emergency Medicine
{ddagger} Pediatric Critical Care Medicine, Department of Pediatrics, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
|| Department of Community and Preventive Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
§ Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Background. Helium and oxygen mixtures (heliox) increase both pulmonary aerosol delivery and gas delivery relative to oxygen. We aimed to compare the effectiveness of a 70%:30% helium/oxygen (heliox)–driven continuous aerosol delivery versus 100% oxygen-driven delivery in the treatment of asthmatic children with moderate to severe exacerbations.

Methods. We enrolled 30 children aged 2 to 18 years who presented to an urban, pediatric emergency department (ED) with moderate to severe asthma as defined by a pulmonary index (PI) score of ≥8. PI scores can range from 0 to 15. In this randomized, controlled, single-blind trial conducted in a convenience sample of children, all patients in the trial received an initial nebulized albuterol (5 mg) treatment driven by 100% oxygen and a dose of oral prednisone or prednisolone. Subsequently, patients were randomly assigned to receive continuously nebulized albuterol (15 mg/hour) delivered by either heliox or oxygen using a nonrebreathing face mask. The primary outcome measure was degree of improvement as assessed in blinded video-recorded PI scores over 240 minutes (at 30-minute intervals for the first 3 hours) or until ED discharge (if <240 minutes).

Results. The mean change in PI score from baseline to 240 minutes or ED discharge was 6.67 for the heliox group compared with 3.33 for the oxygen group. Eleven (73%) patients in the heliox group were discharged from the hospital in <12 hours compared with 5 (33%) patients in the conventional group.

Conclusion. Continuously nebulized albuterol delivered by heliox was associated with a greater degree of clinical improvement compared with that delivered by oxygen among children with moderate to severe asthma exacerbations.

Key Words: asthma • emergency department • heliox • pediatric

Abbreviations: ED, emergency department • heliox, helium/oxygen mixture • PI, pulmonary index

Accepted Feb 4, 2005.




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