The use of Heliox in Hospitalized Children from Cartagena, Colombia: a Case Series

Research Article

Austin J Emergency & Crit Care Med. 2015; 2(5): 1031.

The use of Heliox in Hospitalized Children from Cartagena, Colombia: a Case Series

Guzman-Corena A¹, Orozco-Guardo M¹, Aristizabal G¹, Morales-Payares D², Alvarez- Londoño A¹, Pinzón-Redondo H², Janacet LP¹, Zakzuk J³* and Alvis-Guzmán N2,3

¹Unidad de Cuidados Intensivos “Doña Pilar”, Hospital Infantil Napoleón Franco Pareja, Colombia

²Centro de Investigación y Docencia, Hospital Infantil Napoleón Franco Pareja, Colombia

³Grupo de Investigación en Economía de la Salud, Universidad de Cartagena, Colombia

*Corresponding author: Josefina Zakzuk, GIES, Universidad de Cartagena, Campus de Piedra de Bolívar, Cartagena, Colombia

Received: April 02, 2015; Accepted: September 10, 2015; Published: September 15, 2015


Objective: To describe a case series of patients at risk of acute respiratory failure, who were managed with Heliox.

Methods: A descriptive, retrospective and cross-sectional study about the use of heliox in pediatric patients at risk of respiratory acute failure, admitted to the pediatric health center “Hospital Infantil Napoleón Franco Pareja” from Cartagena, Colombia. Differences in categorical variables were analyzed by chi-square or Fisher exact test.

Results: Fifty two patients were included. The mean age was 21.2±56 months. The two most frequent diagnoses were status asthmaticus (38.5%) and acute bronchiolitis (26.9%). Success of heliox therapy was 76.9%. The route of administration was not related to the type of response. The duration of heliox therapy was in average 5.9 hours (SD±4.1), in patients who did not respond favorably to heliox, and 8.0 hours (SD±5.6) in those who did respond.

Conclusion: A high success rate with heliox therapy was found in this case series. Its use is recommended as an adjunct therapy in the management of acute respiratory insufficiency.

Keywords: Heliox therapy; Bronchiolitis; Asthma; Acute Respiratory


ICU: Intensive Care Unit; SD: Standard Deviation; OI: Orotracheal Intubation


In the last decades, the helium-oxygen mixture (heliox) has been used as a treatment for several respiratory disorders, including acute upper and lower airway obstructive conditions. In the pediatric field, it has gained relevance as a treatment for asthma, bronchiolitis and croup [1]. Helium was introduced in the medical practice in the 30’s decade by Barach. He demonstrated that, in combination with oxygen, the resulting mixture improved airflow in patients with laryngeal, tracheal or lower airway obstructive problems [2]. However, in spite of its benefits, its use was rapidly replaced by bronchodilators [3].

Helium is a colorless, inodorous, tasteless and inert gas with low density. Combined with oxygen, the density of the resulting mixture is three times lower than air; this leads to a less turbulent airflow and a reduction in resistance to gas flow and work of breathing [4]. Furthermore, diffusion of carbon dioxide through helium is four to five times faster than through air, which improves ventilation and carbon dioxide removal. Heliox does not have a pharmacological effect on its own; however, it may act as a therapeutic carrier, retarding muscular fatigue, respiratory failure and avoiding the use of more aggressive treatments. Few secondary effects have been reported for heliox use, which is mainly due to the lack of potential biological interactions.

In this study, we describe a case series of patients, mostly with broncho-obstructive conditions, who were treated with heliox to prevent acute respiratory failure, hospitalized in the medical institution “Hospital Infantil Napoleón Franco Pareja” from Cartagena, Colombia.


A descriptive, retrospective and cross-sectional study about the use of heliox in pediatric patients, admitted to the Hospital Infantil Napoleón Franco Pareja from July 2012 and April 2013. All patients who received heliox therapy, admitted to the pediatric intensive care unit (ICU) or Emergency room service, were included in the study. In our institution, heliox was administered to those patients at risk of acute respiratory failure or as part of an extubation protocol to prevent reintubation. Heliox was used as a carrier of drugs administered by inhaled route. Response to heliox treatment was measured as the prevention of intubation or re-intubation.

Administration of heliox

Inhaling mask: Heliox mixture was composed of helium at 70% and oxygen at 30%. For administration, the patient was placed in prone position; vital signs were monitored. The mask was attached to heliox cylinders through the use of hoses. Heliox was administered at 6-8 L/min, regulated by a valve connected to a pressure gauge.

Non-rebreathing mask or nasal cannula: After observing a good response with inhaling mask, heliox was then administered through a non-rebreathing mask at 8/10 L/min. In some cases, heliox was administered by nasal cannula at 2 L/min (determined by comfort, the size of the patient, and at the discretion of the physician).

Data collection and processing: Data were tabulated in a Microsoft Excel 2010 spreadsheet (Microsoft, Redmond, WA) and analyzed with the same software. Diagnosis at admission, age, gender, clinical evolution, length of hospital stay and discharge diagnosis were recorded. Regarding heliox therapy, the following information was analyzed: administration route, number of therapies, duration of heliox administration, therapy response and need of OI before or after heliox use. Descriptive information about these data was reported as the arithmetic mean and its standard deviation. Differences between proportions were analyzed by Pearson chi-squared test or Fisher exact test, when appropriate.


Fifty two patients were evaluated in this case series; thirty one of them (59.6%) were males. Mean age was 21.2±SD 25.6 months (range: 0.5 months to nine years-old). Girls were significantly older than boys (33.1±28.2 vs. 13.2±20.5 months; p<0.05). The most common diagnoses were status asthmaticus and acute bronchiolitis (Table 1). Twenty patients had been intubated before heliox administration (38.5%). Mortality rate was 5.8% (n=3); death cases had already been intubated before heliox administration.