Heliox Prescribing Trends for Pediatric Critical Asthma

Area of Science:

• Pediatric Critical Care Medicine
• Respiratory Therapy
• Asthma Management

Background:

• Critical asthma (CA) involves severe asthma exacerbations requiring pediatric intensive care unit (PICU) admission.
• Heliox, an inhaled gas mixture, is used in CA to improve medication delivery and respiratory function, potentially avoiding mechanical ventilation.
• Understanding heliox prescription trends and its impact on mechanical ventilation is crucial for optimizing CA treatment.

Purpose of the Study:

• To update estimates of heliox prescription rates in children with CA.
• To investigate the association between heliox use and the frequency and duration of mechanical ventilation in this population.

Main Methods:

• A retrospective cohort study was conducted using data from 97 PICUs between 2013 and 2019.
• The study included children aged 3-17 years admitted for CA.
• Prescribing rates, mechanical ventilation frequency, and duration were analyzed in relation to heliox exposure.

Main Results:

• Heliox was prescribed to 2.5% of 43,238 children with CA, with a declining trend observed from 2013 to 2019.
• Heliox use varied regionally, being higher in the South and Midwest compared to the West and Northeast.
• While heliox use was associated with higher rates of mechanical ventilation, adjusted models indicated no significant association with noninvasive heliox use, nor was there a difference in mechanical ventilation duration.

Conclusions:

• Heliox is an uncommon adjunctive therapy for pediatric CA, used in only 2.5% of cases.
• Current data suggest heliox is not associated with reduced mechanical ventilation use or duration in children with CA.
• Further research, including prospective controlled trials, is needed to clarify the role of heliox in managing critical asthma.