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Heliox tolerance in spontaneously breathing neonates with bronchopulmonary dysplasia
E de Gamarra1, G Moriette, M Farhat
1Service de Médecine Néonatale, Hôpital Port-Royal, Paris, France.
Insights
Heliox, a helium-nitrogen gas mixture, may reduce breathing effort in infants with bronchopulmonary dysplasia (BPD). However, this preliminary study found Heliox caused significant hypoxia in BPD infants, requiring immediate air reintroduction.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Respiratory Physiology
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease in infants.
- Increased work of breathing in BPD can impede growth due to high energy expenditure.
- Heliox (helium-oxygen) is explored to reduce respiratory resistance.
Purpose of the Study:
- To assess the tolerance and physiological effects of Heliox in infants with BPD.
- To evaluate if Heliox reduces energy expenditure for growth in BPD infants.
- To compare respiratory and blood gas parameters between BPD infants and controls breathing Heliox.
Main Methods:
- A preliminary study involving 4 infants with BPD and 4 healthy controls.
- Participants breathed air and then Heliox for 30 minutes, with measurements at 10, 20, and 30 minutes.
- Monitored parameters included respiratory rate, cardiac rate, skin temperature, and transcutaneous blood gases (TcPO2, TcPCO2).
Main Results:
- Breathing Heliox led to immediate adverse effects: increased alertness, crying, decreased skin temperature, and hypoxia.
- Hypoxia was more severe and rapid in the BPD group compared to controls (TcPO2 39±4 vs. 69±7 mmHg at 10 min).
- Hypoxia resolved upon return to room air; TcPCO2 remained unchanged in both groups.
Conclusions:
- Heliox breathing caused significant, rapid hypoxia in infants with BPD.
- The potential benefits of Heliox for reducing work of breathing in BPD require further investigation due to safety concerns.
- Immediate correction of hypoxia upon air reintroduction suggests careful monitoring is essential.
Abstract:
The use of a gas mixture in which helium is substituted for nitrogen allows a decrease in pulmonary resistances and in resistive work of breathing. This treatment might allow a reduction in energy expenditure in infants with bronchopulmonary dysplasia (BPD) and spare calories for growth. In a preliminary study designed to assess tolerance to Heliox(R), 4 infants with BPD and 4 controls were studied firstly when breathing air and secondly when breathing Heliox(R), at 10, 20 and 30 min exposure (T10, T20, T30). The following parameters were recorded: respiratory and cardiac rates, room (RT) and skin temperatures (ST) and transcutaneous (Tc) blood gases. When breathing air, TcPO2 was normal in the two groups (mean +/- SEM: 70 +/- 4 mm Hg in BPD vs. 78 +/-4 in controls). TcPCO2 was higher in the BPD group (41 +/- 2 vs. 35 +/- 1 mm Hg in controls; p = 0.028). Spontaneously breathing Heliox had immediate consequences such as wakening, crying, decrease in ST and hypoxia. Hypoxia was more serious and more rapid in the BPD group. At the 10-min exposure, mean TcPO2 was 39 +/- 4 mm Hg in BPD vs. 69 +/- 7 in controls (p = 0.042). Hypoxia was immediately corrected when breathing room air. TcPCO2 was unchanged in both groups.