Heliox for Pediatric Critical Asthma: A Multicenter, Retrospective, Registry-Based Descriptive Study

Area of Science:

• Pediatric Critical Care Medicine
• Respiratory Therapy
• Health Services Research

Background:

• Critical asthma (CA) management aims to prevent invasive mechanical ventilation (MV).
• Heliox, a helium-oxygen mixture, is explored as an adjunctive therapy for CA.
• Potential benefits include improved medication delivery and airflow in obstructed airways.

Purpose of the Study:

• To evaluate trends in heliox prescribing for pediatric CA.
• To compare rates of MV and hospital length of stay (LOS) between children receiving heliox and those who did not.
• To explore the association between heliox use and MV rates.

Main Methods:

• Retrospective cohort study using the Pediatric Health Information System (PHIS) registry.
• Included children aged 5-17 years admitted for CA from 2010-2019 across 42 pediatric intensive care units.
• Analyzed heliox prescribing rates, MV rates, and LOS, comparing heliox vs. non-heliox groups and different adjunctive therapy combinations.

Main Results:

• Heliox prescribing decreased from 16.1% in 2010 to 5.6% in 2019.
• The overall rate of MV was 12.8%.
• Heliox-only use was associated with significantly lower MV rates (4.9%) compared to heliox with other therapies (31.2%) or non-heliox therapies (22.1%). MV-free hospitalization was associated with heliox-only exposure (OR: 0.33).

Conclusions:

• Heliox prescribing for pediatric critical asthma has declined over the past decade.
• While heliox-only use showed a potential association with reduced MV, the use of multiple adjunctive therapies may indicate greater illness severity.
• Prospective studies are necessary to definitively establish the role of heliox in pediatric CA management.