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Helium-oxygen mixture in the treatment of postextubation stridor in pediatric trauma patients
K J Kemper1, R H Ritz, M S Benson
1Department of Pediatrics, University of Washington, Seattle.
Insights
Helium-oxygen therapy effectively reduced post-extubation stridor scores in pediatric burn and trauma patients. Physicians preferred this helium-oxygen mixture over room air for treating stridor in critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Therapy
- Emergency Medicine
Background:
- Post-extubation stridor is a common complication in pediatric patients with burns or trauma.
- Effective management strategies are crucial to prevent respiratory distress and the need for reintubation.
Purpose of the Study:
- To evaluate the efficacy of a helium-oxygen mixture in mitigating post-extubation stridor in pediatric patients.
- To compare helium-oxygen therapy with oxygen-supplemented room air in this patient population.
Main Methods:
- A randomized, controlled crossover trial was conducted in pediatric burn and trauma intensive care units.
- Children under 15 requiring less than or equal to 35% oxygen were extubated and received either helium-oxygen or room air for 15 minutes.
- Physician assessment using a stridor score and clinical judgment evaluated respiratory distress.
Main Results:
- Helium-oxygen therapy resulted in significantly lower stridor scores compared to oxygen-supplemented room air (2.8 vs. 3.7, p < .005).
- Physicians favored helium-oxygen in 8 out of 9 trials where a preference was noted.
- 47% of patients required subsequent racemic epinephrine or reintubation, highlighting the severity of stridor.
Conclusions:
- Helium-oxygen therapy demonstrates potential as an adjunctive treatment for reducing post-extubation stridor in pediatric trauma patients.
- The clinical preference by physicians suggests practical benefits in managing stridorous pediatric patients.
Objective:
To assess the effectiveness of a helium-oxygen mixture in reducing post-extubation stridor in children hospitalized for burns or trauma.
Design:
Randomized, controlled crossover trial.
Setting:
Harborview Medical Center's Burn and Trauma ICUs from March to September 1989.
Patients:
Children less than 15 yr old who were electively extubated and had symptoms of postextubation stridor, but required less than or equal to 35% oxygen.
Intervention:
Each treatment (helium-oxygen and oxygen-supplemented room air) was given in random order for 15 min after extubation.
Measurements:
Respiratory distress was assessed by a physician blinded to treatment order using a standard stridor score and clinical judgment.
Results:
There were 13 children with 15 extubations; seven (47%) of 15 patients required subsequent treatment with racemic epinephrine or reintubation. Stridor scores were lower with helium-oxygen than with oxygen-supplemented room air (2.8 vs. 3.7, p less than .005), and helium-oxygen was preferred in eight of nine trials in which one treatment was clearly favored by the physician.
Conclusion:
Because helium-oxygen therapy can reduce stridor scores and is clinically preferred by physicians caring for stridorous children, it may be a useful adjunctive therapy in pediatric trauma patients with postextubation stridor.