Use of Helium-Oxygen for Status Asthmaticus in the Pediatric Emergency Department

Abstract 475 Pulmonary: Reactive Airway Diseases I Poster Symposium, Monday, 5/3

Our study investigated the efficacy of helium-oxygen (heliox) as adjuvant therapy for status asthmaticus in the pediatric emergency department. Methods We conducted a prospective double-blind study of 41 children (3-16 y.o.) with a moderate to severe exacerbation of asthma. All children received 3 nebulized albuterol treatments (2.5mg per dose) and IV methylprednisolone (2mg/kg, max.60 mg). Patients were then randomized to receive 70% helium with 30% oxygen (O₂), or 30% O₂ for 20 minutes. All patients were started on continuous nebulized albuterol (.45mg/kg/hr, max. 15mg/hr) concomitant with starting randomized therapy. A dyspnea index (D.I.) score, blood pressure, heart rate, respiratory rate (RR), and capillary blood gas was measured at 4 time intervals: upon arrival (time 1), prior to randomization (time 2), and at 10 and 20 minutes during the randomized therapy (times 3 and 4). The D.I. score evaluated: O₂ saturation, mental status, expiratory wheeze, inspiratory breath sounds and accessory muscle use. Results There was no difference in age, sex or race between groups. There also was no difference in D.I. score, pCO₂ or RR upon arrival or prior to randomization. Using repeated measures ANOVA children in the heliox group had greater improvement in D.I. score, pCO₂ and RR compared to those on O₂. The total length of stay for the heliox group was 16% < in the O₂ group after only 20 minutes of therapy. (Figure) (Table) Conclusion Early intervention with heliox as adjuvant therapy for pediatric status asthmaticus results in improved clinical status and physiologic parameters, and may shorten length of hospitalization.

Fig 1

D.I. Score by Time Interval

Table 1 No caption available.