What is the proper method for administering heliox (helium-oxygen mixture) to a patient?

From the Guidelines

Heliox should be administered via a system that achieves a gas-tight seal, with no leaks between the delivery device and the surroundings, to minimize dilution by room air. The most common mixture used is 70% helium and 30% oxygen (70/30), though 80/20 mixtures may be used for patients without significant hypoxemia 1. When administering heliox, it is crucial to use a delivery system specifically calibrated for heliox, as standard oxygen flowmeters will give inaccurate readings due to helium's lower density.

Key Considerations for Heliox Administration

• The delivery system should be connected to a non-rebreather mask or tight-fitting face mask to ensure a gas-tight seal.
• Flow rates typically start at 10-15 L/min, and the helium-oxygen ratio may need to be adjusted to maintain adequate oxygenation.
• Continuous monitoring of the patient's respiratory status, including work of breathing, oxygen saturation, and respiratory rate, is essential.
• The goal is to keep the saturation in the appropriate target range for the individual patient, usually 94–98% for patients with asthma or upper airway obstruction and 88–92% for patients with severe COPD 1.

Clinical Applications of Heliox

• Heliox therapy is particularly useful for conditions involving upper airway obstruction or severe bronchospasm, as it reduces airway resistance through its lower density compared to air.
• The therapy should be continued until clinical improvement is observed, typically for several hours, after which gradual weaning can begin.
• Ensure oxygen saturation remains above 90% throughout treatment, adjusting the helium-oxygen ratio if necessary to maintain adequate oxygenation 1.

From the FDA Drug Label

For use only by or under the supervision of a licensed practitioner who is experienced in the use and administration of Helium and is familiar with the indications, effects, dosages, methods, and frequency and duration of administration, and with the hazards, contraindications, and side effects and the precautions to be taken. Use equipment rated for cylinder pressure. Use a back flow preventive device in the piping.

The proper method for administering heliox (helium-oxygen mixture) to a patient is to be done only by or under the supervision of a licensed practitioner who is experienced in its use and administration. The administration should be done using equipment rated for cylinder pressure and with a back flow preventive device in the piping. 2

From the Research

Administration of Heliox

To administer heliox, a mixture of helium and oxygen, to a patient, the following steps can be considered:

• Heliox can be administered as a mixture of 70% helium and 30% oxygen 3, 4, 5.
• The administration of heliox can be done through a nonrebreather reservoir face mask 4.
• The duration of heliox therapy can vary, with some studies administering it for 20 minutes 3, 60 minutes 3, or continuously for three hours 3.
• The effectiveness of heliox may depend on the severity of the condition being treated, with some studies suggesting it may be beneficial in the short term for children with moderate to severe croup treated with dexamethasone 3, 5.

Key Considerations

• The evidence for the effectiveness of heliox is limited, and more research is needed to fully understand its role in the treatment of various conditions 3, 4, 5, 6.
• Heliox may not be more effective than 30% humidified oxygen for children with mild croup, but may be beneficial in the short term for children with moderate to severe croup treated with dexamethasone 3, 5.
• The use of heliox may require careful consideration of the individual patient's needs and medical history, as well as close monitoring of their response to treatment 4, 6.

Potential Benefits and Risks

• Potential benefits of heliox include improved clinical scores, reduced respiratory rate, and shorter length of stay in the pediatric intensive care unit (PICU) 4.
• Potential risks and adverse effects of heliox are not well established, and more research is needed to fully understand its safety profile 3, 4, 5, 6.