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Heliox setup for the difficult airway

last modified on: Wed, 10/11/2023 - 15:12

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return to: Difficult Airway; Adult Airway in the Operating Room; Emergency Airway Cart

see also: Tracheostomy and Upper Airway Management Symposium July 30 2016 IAO and SOHN Iowa City Iowa

Heliox has a lower density than air or oxygen regardless of the concentration of helium in the mixture. It improves airflow through constricted passages. Disadvantages include expense, special equipment and training.

It has been reported that for heliox administration to be effective, the helium concentration "must ideally be > 60%, and gas flows must meet or exceed the inspiratory flow demands of the patient so that heliox concentration is not diluted with room air" (Morgan et al 2014).

Research has focused on pediatric populations with both upper (eg croup) and lower (eg asthma) airway obstruction with the focus on case series.

References:

Morgan S, Vukin K, Mosakawoski S, Solano P, Stanton L, Lester L, Lavani R, hall JB and tung A: Use of Heliox Delivered via High-Flow Nasal Cannual to Treat an Infant with Coronavirsu-Related Respiratory Infection and Severe Acute Air-flow Obstruction"  Respir Care 2014;59 (11):e166-1170

Kass JE, Castriotta RJ. Heliox therapy in acute severe asthma. Chest 1995;107:757–60.

Gluck EH, Onorato DJ, Castriotta R. Helium-oxygen mixtures in intubated patients with status asthmaticus and respiratory acidosis. Chest 1990;98:693–8.

Khanlou H, Eiger G. Safety and efficacy of heliox as a treatment for upper airway obstruction due to radiation-inducedlaryngeal dysfunction.Heart Lung2001;30:146–7.

Milner QJ, Abdy S, Allen JG. Management of severe tracheal obstruction with helium/oxygen and a laryngeal mask airway. Anaesthesia 1997;52:1087–9.

McGarvey JM and Pollack CV: Heliox in Airway Management   Emerg Med Clin N Am 26 (2008) 905-920

Randomized clinical trials have studied Heliox in asthma or COPD exacerbations (McGarvey and Pollack 2008).

Useful combinations of heliox have been reported to include 80:20 ratio (80% helium: 20% oxygen)- (Milner et al 1997; Khanlou and Eiger 2001) as well as 60:40 or 70:40 (60-70% helium: 30-40% oxygen) (Kass and Castriotta 1995; Gluck et al 1990))