PRAXAIR HEALTHCARE SERVICES INFORMATION SHEET HELIOX Heliox Is a Prepackaged Blend of Helium USP and Medical Oxygen USP

PRAXAIR HEALTHCARE SERVICES INFORMATION SHEET HELIOX Heliox is a prepackaged blend of helium USP and medical oxygen USP. Conventionally, heliox has been supplied with helium at 70% or 80%, balanced with oxygen. Substituting helium for nitrogen in a gas mixture changes the physical properties of the inhaled gas decreasing density and increasing the propensity for laminar air flow in patients’ airways. The medical use of heliox as a breathable gas for respiratory disease was first introduced in 1934 by Barach1. Since then, heliox has been studied in a variety of upper and lower airway conditions. Reference 1. Barach, AL,. Use of helium as a new therapeutic gas. Proc Soc Exp Biol Med 1934; 32: 462-464

Information on heliox is available from ABSTRACTS FROM events sponsored by the American HELIOX PUBLICATIONS Association of Respiratory Care (AARC). Information on heliox is available • 2004 professor’s round by in scientific and medical literature, Michael Gentile, RRT “Helium such as the following articles: and Nitric Oxide – Getting the Helium/Oxygen-Driven Albuterol most of Alternative Gas Nebulization in the Treatment of Therapies”. Children With Moderate to Severe • Webcast on January 26, 2005 by Asthma Exacerbations: A Randomized, Dean Hess PhD RRT “Heliox Controlled Trial Therapy”. This webcast is available In K. Kim, MD; Erin Phrampus, on the AARC’s online continuing MD, MPH; Shekhar education system–until Dec 31, Venkataraman, MD; Raymond 2005. Pitetti, MD, MPH; Al Saville, 100% oxygen driven delivery • AARC’s 51st Annual Congress RRT; Timothy Corcoran, PhD; Ed in the treatment of asthmatic Saturday, December 3, 2005 Gracely, PhD; Nicole Funt, children with moderate to (1:00 pm to 4:50 pm) San Antonio MPAS, PA-C; and Ann severe exacerbations. Convention Center (Ballroom Thompson, MD Methods: We enrolled 30 children C), TX. A symposium on (Pediatrics 2005;116:1127-1133) aged 2 to 19 years who presented Heliox Therapy: Practice, Background: Helium and oxygen to an urban, pediatric emergency Evidence, Risk and mixtures (heliox) increase both department (ED) with moderate to Opportunities. Please check pulmonary aerosol delivery and severe asthma as defined by a AARC program for details. gas delivery relative to oxygen. pulmonary index (PI) score of We aimed to compare the greater pr equal to 8. PI scores can For further information, please effectiveness of a 70%:30% range from 0 to 15. In this ran- visit our web site: helium/oxygen (heliox) driven domized, controlled, single-blind http://www.praxair.com/heliox continuous aerosol delivery versus trial conducted in a convenience sample of children, all patients in the trial received early in an acute disease process. Any beneficial an initial nebulized albuterol (5 mg) treatment driven effect of heliox shall become evident in a relatively by 100% oxygen and a dose of oral prednisone or short period of time. The medical literature supports prednisolone. Subsequently, patients were randomly the use of heliox to relieve respiratory distress, assigned to receive continuously nebulized albuterol decrease the work of breathing, and improve gas (15 mg/hour) delivered by either heliox or oxygen exchange. No adverse effects of heliox have been using a nonrebreathing face mask. The primary reported. However, heliox must be administered outcome measure was degree of improvement as with vigilance and continuous monitoring to avoid assessed in blinded video-recorded PI scores over 240 technical complications. minutes (at 30-minute intervals for the first 3 hours) or until ED discharge (if <240 minutes). Helium-oxygen Reduces Work of Breathing in Mechanically Ventilated Patients with Chronic Results: The mean change in PI score from baseline Obstructive Pulmonary Disease to 240 minutes or ED discharge was 6.67 for the Marc Gainnier, Jean-Michael Arnal, Patrick heliox group compared with 3.33 for the oxygen group. Gerbeaux, Stephane Donati, Laurent Papazian, Eleven (73%) patients in the heliox group were Jean-Marie Sainty (Intensive Care Med 2003 discharged from the hospital in <12 hours, compared 29:1666-1670) with 5 (33%) patients in the conventional group. Objective: To evaluate whether helium-oxygen Conclusion: Continuously nebulized albuterol mixture reduces inspiratory work of breathing delivered by heliox was associated with a greater (WOB) in sedated, paralyzed, and mechanically degree of clinical improvement compared with that ventilated patients with acute exacerbation of delivered by oxygen among children with moderate chronic obstructive pulmonary disease (COPD). to severe asthma exacerbations. Design and setting: Open prospective, randomized, crossover study in the medical intensive care unit in Heliox Administration in the Pediatric Intensive Care Unit: a university hospital. An Evidence-Based Review Vineet K. Gupta, MD; Ira M. Cheifetz, MD, FCCM Patients and participants: 23 patients admitted (Pediatr Crit Care Med 2005; 6:204-211) for acute exacerbation of COPD and mechanically ventilated. Objective: To provide a comprehensive, evidence-based review of helium-oxygen gas Measurements: Total WOB (WOBt), elastic WOB mixtures (heliox) in the management of pediatric (WOBel), resistive WOB (WOBres), and WOB due respiratory diseases. to PEEPi (WOBPeepi) were measured. Static Data Source: A thorough, computerized bibliographic intrinsic positive and expiratory pressure (PEEPi) search of the preclinical and clinical literature static compliance (Crs), inspiratory resistance regarding the properties of helium and its application (Rins), inspiratory (tinsp), and expiratory time in pediatric respiratory disease states. constant (texp) were also measured. These Data Synthesis: After an overview of the potential variables were compared between air-oxygen and benefits and technical aspects of helium-oxygen gas helium-oxygen mixtures. mixtures, the role of heliox is addressed for asthma, Results: WOBt significantly decreased with aerosolized medication delivery, upper airway helium-oxygen (2.34±1.04 to 1.85±1.01 J/L, obstruction, postextubation stridor, croup, bronchiolitis, p<0.001). This reduction was significant for WOBel and high-frequency ventilation. The available data are (1.02±0.61 J/L to 0.87±0.47, p<0.01) WOBPeepi objectively classified based on the value of the (0.77±0.38 J/L to 0.54± 0.38, p<0.001), and therapy or intervention as determined by the study WOBres (0.55±0.19 J/L to 0.44±0.24, p<0.05). design from which the data are obtained. PEEPi, Rins, tinsp and texp significantly decreased. Conclusions: Heliox administration is most effective Crs was unchanged. during conditions involving density-dependent Conclusions: Helium-oxygen mixture decreases increases in airway resistance, especially when used WOB in mechanically ventilated COPD patients. Helium-oxygen mixture could with heliox leads to a more Demographic data, age, time be useful to reduce the burden significant improvement in elapsed from the start of the of ventilation. spirometry when compared with symptoms to the admission to albuterol nebulized with oxygen. PICU, length of stay in PICU The Utility of Albuterol Nebulized This is likely due to the low-den- (PICU-LOS), and duration of with Heliox During Acute sity gas improving albuterol heliox therapy were also Asthma Exacerbations deposition in the distal airways. collected for each patient. John P. Kress, Imre Noth, Brian Heliox Therapy in Infants with Reductions in clinical scores and K. Gehlbach, Nitin Barman, Acute Bronchiolitis PICU-LOS were considered Anne S. Pohlman, Annette primary outcomes. Federico Martinón-Torres, MD, Miller, Sherwin Morgan, and PhD; Antonio Rodríguez-Núñez, Main Results: At baseline, the Jesse B. Hall MD, PhD; and Jose María heliox and control groups had (Am J Respir Crit Care Med Vol. Martinón-Sánchez, MD, PhD similar age (5.5 ± 3.1 vs 5.9 ± 3 165 pp 1317-1321, 2002) Pediatrics 2002;109:68-73 months), previous length of course (47.3 ± 19.3 vs 45.4 ± Heliox improves lung deposition of Objective: To assess the thera- 18.6 hours), clinical score (6.7 ± inhaled particles when compared peutic effects of breathing a 1.1 vs 6.6 ± 1) heart rate (160 ± with air or oxygen inhalation. We low-density gas mixture (heliox: 24 vs 165 ± 20 beats per minute), studied the spirometric effects of 70% helium and 30% oxygen) in respiratory rate (64 ± 7 vs 61 ± 7 albuterol nebulized with heliox infants with bronchiolitis. during emergency room visits for respirations per minute), satO2 Design: Prospective, interventional, asthma exacerbations. Forty-five (91 ± 2.3 vs 91 ± 2.5%), and comparative study. patients were randomized to etCO2 (34 ± 7 vs 33 ± 6 mm Hg). receive albuterol nebulized with Setting: A pediatric intensive care Clinical score, heart rate, respira- oxygen (control) versus heliox unit (PICU) in a tertiary care, tory rate, and satO2 improved during (n = 22 control and 23 heliox teaching hospital. the study in both groups. After 1 subjects). At baseline, demographics, Patients: Thirty-eight infants, 1 hour, the improvement in clinical outpatient asthma medications, month to 2 years old, consecutively score was significantly higher in the vital signs, oxygen saturation, admitted to the PICU for treatment heliox group than in the control and forced expiratory volume in of moderate-to-severe acute group (3.6 ± 1.16 vs 5.5 ± 0.89), one second were not different respiratory syncytial virus and these differences continued between the two groups. Three bronchiolitis. to be significant at the end of the consecutive albuterol treatments observation period (2.39 ± 0.69 were given to each group. The Interventions: The first 19 patients and 4.07 ± 0.96, respectively), heliox group had a significantly were enrolled as the control with a total average decrease in higher heart rate after albuterol group, and received supportive the score of 4.2 points in the heliox nebulization compared with the care and nebulized epinephrine. group versus 2.5 points in the control group. Following albuterol In the next 19 patients, heliox control group. Heart and respira- Treatment 1, the median change therapy was added through a tory rates were also significantly in forced expiratory volume in nonrebreather reservoir face mask. lower in the heliox group compared one second was 14.6% in the Measurements and Outcomes: with the control group after 1 control group and 32.4% in the Respiratory distress score, hour and stayed lower throughout heliox group (p = 0.007). After respiratory rate, heart rate, the rest of the study period. No Treatment 2, the results were end-tidal CO2 (etCO2), and pulse changes were noted either in satO2 22.7% versus 51.5%, respectively oximetry oxygen saturation between groups or in etCO2 within (p = 0.007). After Treatment 3, the (satO2) values were recorded at or between groups throughout the results were 26.6% versus 65.1%, baseline and at regular intervals. study. Mean duration of heliox respectively) p = 0.016). We Data obtained during the first 4 administration was 53 ± 24 conclude that during acute asthma hours were analyzed for hours (range: 24-112 hours) and exacerbations, albuterol nebulized comparison purposes. no adverse effects were detected. PICU-LOS was significantly shorter in the heliox randomized, controlled trial. In all patients, baseline group (3.5 ± 1.1 days) than in the control group data, including pulsus paradoxus (determined by (5.4 ± 1.6 days). sphygmomanometer or arterial catheter blood Conclusions: In infants with moderate-to-severe pressure readings), respiratory rate, heart rate, respiratory syncytial virus bronchiolitis, heliox therapy investigator-scored dyspnea index, and oxygen enhanced their clinical respiratory status, according saturation, were compared with values obtained 15 to the marked improvement in their clinical scores minutes during and after intervention. In a subset of and the reduction of the accompanying tachycardia patients, peak flows before and after breathing heliox and tachypnea. This beneficial response occurred or room air were measured. When clinically indicated, within the first hour of its administration and was arterial blood gases were obtained. maintained as long as heliox therapy continued. In Results: The pulsus paradoxus (in millimeters of addition, PICU-LOS was reduced in heliox-treated mercury) fell significantly from an initial mean patients. Long-term prospective studies are required to corroborate these findings and to establish the value of 23.3 ± 6.8 to 10.6 ± 2.8 with heliox breathing proper place of heliox in the therapeutic schedule (p <0.001) and increased again to 18.5 ± 7.3 after of bronchiolitis. cessation of heliox. Peak flow increased 69.4% ± 12.8% during heliox breathing (p <0.05). The dyspnea Index Inhaled Helium-Oxygen Revisited: Effect of Inhaled decreased from an initial mean value of 5.7 ± 1.3 to Helium-Oxygen During the Treatment of Status 1.9 ± 1.7 with heliox breathing (p <0.0002) and Asthmaticus in Children increased again to 4.0 ± 0.5 after cessation of heliox Theresa M. Kudukis, MD, Constantine A. breathing. In control patients, there was no significant Manthous, MD, Gregory A. Schmidt, MD, Jesse B. difference in pulsus paradoxus or dyspnea index at any Hall, MD and Mark E. Wylam, MD time during the study period. Mechanical ventilation (J Pediatr 1997; 130:217-224) was averted in three patients in whom dyspnea Objectives: To assess the effects of breathing a lessened dramatically during breathing of heliox. low-density gas mixture on dyspnea and the pulsus Conclusion:During acute status asthmaticus, paradoxus in children with status asthmaticus. inhaled heliox significantly lowered the pulsus Design: In an urban academic tertiary referral paradoxus, increased peak flow, and lessened the center, 18 patients, aged 16 months to 16 years, dyspnea index. Moreover, heliox spared three who were being treated for status asthmaticus with patients a planned intubation and caused no apparent continuously inhaled beta-agonist and intravenously side effects. Thus heliox reduces the work of administered methylprednisolone and had a pulsus breathing and may forestall respiratory failure in paradoxus of greater than 15 mm Hg received either children with status asthmaticus, thus preventing an 80%:20% helium-oxygen gas mixture (heliox the need for mechanical ventilation. patients) or room air (control patients) at 10 L/min by nonrebreathing face mask in a double-blind,