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Helium-oxygen therapy improves treatment of infants with bronchiolitis

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Infants seen in the emergency department with bronchiolitis have greater improvements over 4 hours when they receive helium-oxygen therapy rather than pure oxygen, according to a report in the December issue of the Archives of Pediatrics and Adolescent Medicine.

“Our findings suggest that helium-oxygen may serve a future role as an adjunct therapy for severe bronchiolitis,” comment Dr. In K. Kim, at Kosair Children’s Hospital in Louisville, Kentucky, and colleagues.

Their study was based on the premise that helium-oxygen improves gas flow through high-resistance airways. The objective was to determine the effectiveness of helium-oxygen compared with oxygen in infants with bronchiolitis, first in delivering nebulized racemic epinephrine and then as a component of subsequent inhalation therapy.

The team enrolled 69 infants ages 2 to 12 months with a modified Wood’s Clinical Asthma Score (M-WCAS) of 3 or higher.

After first receiving nebulized albuterol via 100% oxygen, the patients were randomized to receive racemic epinephrine delivered either by 100% oxygen or by 70% helium and 30% oxygen, vial high-flow nasal cannula. A second dose of epinephrine was given after an hour if needed, otherwise the patients continued on inhalation therapy with their assigned study gas.

The main outcome measure, the mean change in M-WCAS score from baseline to 240 minutes, was a drop of 1.84 points in the helium-oxygen group compared with just 0.31 for the oxygen group (p<0.001), the investigators found.

In fact, even though the mean M-WCAS score was slightly higher in the helium-oxygen group at baseline, it was significantly better than in the oxygen group at all subsequent time points, Dr. Kim and colleagues report.

“Our small investigation demonstrated a statistically and clinically significant short-term improvement in clinical scores among a small group of patients with bronchiolitis compared with controls,” they conclude.

However, they add, “These results will require confirmation with an expanded focus on masked short-term clinical outcomes, including ED length of stay, admission rates, and complications.”


Arch Pediatr Adolesc Med 2011;165:1115-1122.