Published online May 26, 2009
PEDIATRICS Vol. 123 No. 6 June 2009, pp. 1524-1528 (doi:10.1542/peds.2008-0937)
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ARTICLE

The Effects of Helium/Oxygen Mixture (Heliox) Before and After Extubation in Long-term Mechanically Ventilated Very Low Birth Weight Infants

Claudio Migliori, MDa, Paolo Gancia, MDb, Elena Garzoli, MDa, Vania Spinoni, MDa and Gaetano Chirico, MDa

a Department of Neonatology and Neonatal Intensive Care, Spedali Civili Hospital, Brescia, Italy
b Neonatology and Neonatal Intensive Care Unit, ASO St Croce and Carle Hospital, Cuneo, Italy

OBJECTIVES. Our goal was to evaluate the effects of a helium/oxygen mixture (heliox) on pulmonary mechanics and gas exchange in preterm infants during both conventional and noninvasive ventilation.

PATIENTS AND METHODS. Ten preterm infants, ventilated from birth, were enrolled. Resistive work of breathing, pulmonary compliance, static compliance, respiratory rate, minute ventilation, ventilatory support, and gas exchange were measured before and during treatment. One hour after heliox therapy, subjects who showed a decrease of peak inspiratory pressure of >20% of the initial value were extubated and shifted to nasal bilevel positive airway pressure with heliox for the following 3 hours. Pulmonary mechanics and ventilatory parameters were measured during air/oxygen ventilation and again 10 minutes and 1 hour after starting heliox. Transcutaneous pressure of O2 and CO2, oxygen saturation, and respiratory rate were recorded continuously. Arterial blood gases were measured immediately before and 1 hour after initiating bilevel positive airway pressure. To maintain oxygen saturation at >92% during the bilevel positive airway pressure phase, the mean fraction of inspired oxygen was increased from 0.34 to 0.36.

RESULTS. Mean peak inspiratory pressure decreased from 21.4 to 17.4 cmH2O, work of breathing decreased from 0.46 to 0.22 joule/L, and transcutaneous pressure of CO2 decreased from 52.3 to 49.1 mmHg. Mean transcutaneous pressure of O2 improved from 42.8 to 46.7 mmHg, and minute ventilation improved from 332 to 478 mL/kg per minute. No significant differences were observed in mean airway pressure, respiratory rate, oxygen saturation, pulmonary compliance, and static compliance. Eight infants were extubated. One of them needed to be reintubated after 5 hours.

CONCLUSIONS. Our data show that mechanical ventilation with heliox reduces resistive work of breathing and ventilatory support requirements and improves gas exchange in preterm infants.

Key Words: mechanical ventilation • heliox • preterm infants • weaning • pulmonary function

Abbreviations: heliox—helium/oxygen mixture • PIP—peak inspiratory pressure • VT—tidal volume • BiPAP—bilevel positive airway pressure • TI—inspiratory time • RR—respiratory rate • Vmin—minute ventilation • FIO2—fraction of inspired oxygen • WOB—work of breathing • Cdyn—pulmonary compliance • Cstat—static compliance • TcpO2—transcutaneous pressure of O2 • TcpCO2—transcutaneous pressure of CO2 • MAP—mean airway pressure • NS—not significant

Accepted Oct 23, 2008.


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eLetters:

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Heliox in long-term mechanically ventilated very low birth weight infants: still a premature treatme
Pierantonio Santuz, et al.
Pediatrics Online, 1 Jul 2009 [Full text]
Author's reply
Claudio Migliori, et al.
Pediatrics Online, 13 Aug 2009 [Full text]