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Helium–oxygen mixture enhanced NCPAP in premature infants with RDS
Colnaghi M. Pediatrics. 2012;129:e333-338.
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Premature infants with respiratory distress syndrome are less likely to require mechanical ventilation after the addition of heliox, a low-density helium-oxygen mixture, to nasal continuous positive airway pressure treatment, according to study results published online.
Mariarosa Colnaghi, MD, and colleagues at the NICU Fondazione IRCCS Cà Granada – Ospedale Maggiorie Policlinico, Università degli Studi di Milano in Milan, Italy, examined data from 51 newborn infants between the gestational ages of 28 and 32 weeks who had clinical symptoms confirmed with radiological findings of respiratory distress syndrome (RDS) from February 2008 to September 2010.
While receiving nasal continuous positive airway pressure treatment (NCPAP), 24 infants randomly assigned to the control group received standard medical air, whereas 27 received heliox in a 4:1 helium–oxygen mixture for the first 12 hours of enrollment. This treatment was followed by standard medical air for the duration of NCPAP treatment.
Researchers discovered that only 14.8% of the heliox group required mechanical ventilation compared with 45.8% of the control group.
“Heliox delivered with NCPAP is safe and effective in reducing the need of intubation in the first week of life in premature infants with RDS,” Colnaghi and colleagues said. “This was a pilot study, and no definitive conclusions can be drawn on the basis of our results.”
They said follow-up study is needed.
Disclosure: The researchers report no relevant financial disclosures.
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Colnaghi and colleagues in a small study demonstrated a therapeutic application of heliox in the NICU. It is impressive to see that in infants with respiratory distress syndrome who required less than 40% oxygen on CPAP, 12 hours of heliox prevented the need for intubation for surfactant replacement (using their criteria of requiring more than 40% oxygen on CPAP).
For a disease in which surfactant deficiency leads to atelectasis, lung and airway injury, how did heliox in the first 12 hours after birth improve outcomes? While it makes sense that heliox could improve gas flow dynamics for the 12 hours it was administered, are these 12 hours a critical time period and/or did heliox have an effect on the airways and lung that persisted after its use? One could hypothesize that heliox: 1) facilitated air entry into smaller air units with CPAP maintaining airway distention, preventing atelectasis during it use and maintaining distention afterwards; 2) provided time for the necessary amount of endogenous surfactant production for these patients; and/or 3) had anti-inflammatory action that prevented secondary airway and lung injury.
As the authors note, the cost is significant: 750 € for 12 hours of heliox, which is higher than the cost for one dose of surfactant in many institutions. Future studies should examine outcomes using higher FiO2 and specific CPAP settings for intubation/surfactant, as some centers use 50% to 60% oxygen and CPAP of 6 mmHg to 8 mmHg. Hopefully this study will jump start further research in its application for many other conditions such as infants with severe chronic lung disease and those with restrictive airways. For too long, we have ignored looking at the potential benefit of heliox for our patients in the NICU.
David A. Kaufman, MD
Professor of Pediatrics
University of Virginia Health System
Charlottesville, Va.
Disclosure: Dr. Kaufman reports no relevant financial disclosures.
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