Gustavo J Rodrigo1, Jose A Castro-Rodriguez2. 1. Departamento de Emergencia, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay. Electronic address: gustavo.javier.rodrigo@gmail.com. 2. Departments of Pediatrics and Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Abstract
BACKGROUND: The effect of heliox as a nebulizer β2-agonist driving gas in acute asthma remains controversial. OBJECTIVE: To perform a systematic review with a meta-analysis of randomized trials designed to evaluate the efficacy of heliox versus oxygen in driving β2-agonist nebulization in patients with acute asthma. METHODS: A search was conducted of all randomized controlled trials published before August 2013. Primary outcomes were change in spirometric measurements and severity composite score (pediatric studies); secondary outcomes were hospitalizations and serious adverse effects. RESULTS: Eleven trials from 10 studies (697 participants) met the inclusion criteria (7 included adults and 3 included children). The mean duration of heliox therapy was 120 minutes and the most common helium-oxygen mixture used was 70:30. Patients receiving heliox presented a statistically significant difference for mean percentage of change in peak expiratory flow (17.2%; 95% confidence interval 5.2-29.2, P = .005). Post hoc subgroup analysis showed that patients with severe and very severe asthma showed a significant improvement in peak expiratory flow compared with those with mild to moderate acute asthma. Heliox-driven nebulization also produced significant decreases in the risk of hospitalizations (odds ratio 0.49, 95% confidence interval 0.31-0.79, P = .003) and severity of exacerbations (pediatric studies; standard mean difference -0.74, 95%% confidence interval -1.45 to -0.03, P = .04). There were no group differences for serious adverse effects. CONCLUSION: This review suggests that heliox benefits in airflow limitation and hospital admissions could be considered clinically significant. Data support the use of heliox as a nebulizing β2-agonist driving gas in the routine care of patients with acute asthma.
BACKGROUND: The effect of heliox as a nebulizer β2-agonist driving gas in acute asthma remains controversial. OBJECTIVE: To perform a systematic review with a meta-analysis of randomized trials designed to evaluate the efficacy of heliox versus oxygen in driving β2-agonist nebulization in patients with acute asthma. METHODS: A search was conducted of all randomized controlled trials published before August 2013. Primary outcomes were change in spirometric measurements and severity composite score (pediatric studies); secondary outcomes were hospitalizations and serious adverse effects. RESULTS: Eleven trials from 10 studies (697 participants) met the inclusion criteria (7 included adults and 3 included children). The mean duration of heliox therapy was 120 minutes and the most common helium-oxygen mixture used was 70:30. Patients receiving heliox presented a statistically significant difference for mean percentage of change in peak expiratory flow (17.2%; 95% confidence interval 5.2-29.2, P = .005). Post hoc subgroup analysis showed that patients with severe and very severe asthma showed a significant improvement in peak expiratory flow compared with those with mild to moderate acute asthma. Heliox-driven nebulization also produced significant decreases in the risk of hospitalizations (odds ratio 0.49, 95% confidence interval 0.31-0.79, P = .003) and severity of exacerbations (pediatric studies; standard mean difference -0.74, 95%% confidence interval -1.45 to -0.03, P = .04). There were no group differences for serious adverse effects. CONCLUSION: This review suggests that heliox benefits in airflow limitation and hospital admissions could be considered clinically significant. Data support the use of heliox as a nebulizing β2-agonist driving gas in the routine care of patients with acute asthma.
Authors: Jakob I McSparron; Margaret M Hayes; Jason T Poston; Carey C Thomson; Henry E Fessler; Renee D Stapleton; W Graham Carlos; Laura Hinkle; Kathleen Liu; Stephanie Shieh; Alyan Ali; Angela Rogers; Nirav G Shah; Donald Slack; Bhakti Patel; Krysta Wolfe; William D Schweickert; Rita N Bakhru; Stephanie Shin; Rebecca E Sell; Andrew M Luks Journal: Ann Am Thorac Soc Date: 2016-05
Authors: Andrew G Miller; Kaitlyn E Haynes; Rachel M Gates; Kanecia O Zimmerman; Travis S Heath; Kathleen W Bartlett; Heather S McLean; Kyle J Rehder Journal: Respir Care Date: 2019-05-14 Impact factor: 2.258