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Heliox Prescribing Trends for Pediatric Critical Asthma
Alicia Lew1, John M Morrison2, Ernest K Amankwah3
1Department of Pediatrics, University of South Florida College of Medicine, Tampa, Florida.
Insights
Heliox therapy for pediatric critical asthma (CA) is uncommon, used in only 2.5% of cases. This study found heliox did not reduce mechanical ventilation use or duration in children with severe asthma exacerbations.
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.
Background:
Children with asthma exacerbations requiring pediatric ICU (PICU) admission, known as critical asthma (CA), are prescribed a variety of therapeutic interventions including heliox. Delivered invasively and noninvasively, heliox is employed to enhance deposition of aerosolized medications, improve obstructive pulmonary pathophysiology, and avoid complications associated with invasive mechanical ventilation. We used the Virtual Pediatric Systems database to update estimates of heliox prescription and explore for relationships between heliox and mechanical ventilation frequency and duration.
Methods:
We performed a retrospective cohort study using data from 97 PICUs among children 3-17 y of age admitted for CA from 2013-2019. The primary outcome was heliox prescribing rates and trends. Subgroup analyses assessed mechanical ventilation rates and duration by heliox exposure.
Results:
Of 43,238 subjects studied, 1,070 (2.5%) were prescribed heliox. Mean heliox prescribing rates fell from 4.11% in 2013 to 2.37% in 2019. Heliox use was greater from centers in the South (2.6%) and Midwest (3.3%) as compared to the West (1.6%) and Northeast United States (1.6%, P < .001). In the subgroup assessing mechanical ventilation frequency, mechanical ventilation rates were 273/39,739 (0.7%) and greater for those provided heliox (1.9% vs 0.7%, P < .001). In the subgroup assessing mechanical ventilation duration, no differences in median mechanical ventilation duration were observed (4.94 [interquartile range [IQR] 3.04-6.36] vs 4.63 [IQR 3.11-7.30] d; P = .35) for those with and without heliox. In exploratory adjusted models, noninvasive heliox was not associated with mechanical ventilation. Mortality was rare (206/43,238 [0.47%]) and predominantly among subjects intubated prehospitalization (188/206 [91.3%]).
Conclusions:
Heliox as adjunctive therapy for children with CA is uncommon (2.5%) and not associated with mechanical ventilation or decreased mechanical ventilation duration in adjusted models. Updated estimates provided herein inform prospective controlled trial development to better define the role of heliox for CA.
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