A multicenter, randomized trial of noninvasive ventilation with helium-oxygen mixture in exacerbations of chronic obstructive lung disease.

Abstract

OBJECTIVE:

To assess the effect of a helium-oxygen mixture on intubation rate and clinical outcomes during noninvasive ventilation in acute exacerbation of chronic obstructive pulmonary disease.

DESIGN:

Multicenter, prospective, randomized, controlled trial.

SETTING:

Seven intensive care units.

PATIENTS:

A total of 204 patients with known or suspected chronic obstructive pulmonary disease and acute dyspnea, Paco2> 45 mm Hg and two among the following factors: pH <7.35, Paco2 <50 mm Hg, respiratory rate >25/min.

INTERVENTIONS:

Noninvasive ventilation randomly applied with or without helium (inspired oxygen fraction 0.35) via a face mask.

MEASUREMENTS AND MAIN RESULTS:

Duration and complications of NIV and mechanical ventilation, endotracheal intubation, discharge from intensive care unit and hospital, mortality at day 28, adverse and serious adverse events were recorded. Follow-up lasted until 28 days since enrollment. Intubation rate did not significantly differ between groups (24.5% vs. 30.4% with or without helium, p = .35). No difference was observed in terms of improvement of arterial blood gases, dyspnea, and respiratory rate between groups. Duration of noninvasive ventilation, length of stay, 28-day mortality, complications and adverse events were similar, although serious adverse events tended to be lower with helium (10.8% vs. 19.6%, p = .08).

CONCLUSIONS:

Despite small trends favoring helium, this study did not show a statistical superiority of using helium during NIV to decrease the intubation rate in acute exacerbation of chronic obstructive pulmonary disease.

• Authors: Salvatore Maurizio Maggiore, Jean-Christophe M Richard, Fekri Abroug, Jean Luc Diehl, Massimo Antonelli, Philippe Sauder, Jordi Mancebo, Miquel Ferrer, Francois Lellouche, Laurent Lecourt, Gaetan Beduneau, Laurent Brochard
• Journal: Critical care medicine (Crit Care Med) Vol. 38 Issue 1 Pg. 145-51 (Jan 2010) ISSN: 1530-0293 [Electronic] United States
• PMID: 19730250 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Helium
• Oxygen

Topics

• Aged
• Blood Gas Analysis
• Critical Care (methods)
• Female
• Helium (therapeutic use)
• Humans
• Intensive Care Units
• Length of Stay
• Male
• Masks
• Middle Aged
• Oxygen (therapeutic use)
• Oxygen Inhalation Therapy (methods)
• Probability
• Prognosis
• Prospective Studies
• Pulmonary Disease, Chronic Obstructive (diagnosis, therapy)
• Pulmonary Gas Exchange
• Recurrence
• Respiration, Artificial (methods)
• Respiratory Function Tests
• Risk Assessment
• Severity of Illness Index
• Treatment Outcome