Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Efficacy of helium — oxygen mixtures in the management of severe viral and post-intubation croup

  • 992 Accesses

  • 75 Citations

Summary

An appreciable number of children with viral or post-intubation croup progress to respiratory failure necessitating an artificial airway. We report seven such patients with critical airway narrowing in whom we reduced the work of breathing by deploying helium rather than air as a carrier gas for oxygen. Assessment of patients by a croup-scoring system and blood gas analysis suggests helium-oxygen mixtures to be a useful alternative to intervention with tracheostomy or tracheal intubation. The rationale and limitations of this treatment are discussed.

Résumé

Un certain nombre ďenfants présentant un faux-croup ďorigine virale ou secondaire à une intubation, évoluent vers une insuffisance respiratoire nécessitant une réintubation ou une trachéostomie. Nous rapportons sept de ces cas avec atteinte grave où ľon a pu réduire le travail de la respiration avec ľemploi ďun mélange helium-oxygène au lieu ďun mélange airoxygène. Ľévolution de ces enfants évaluée au moyen de ľéchelle de Downes (Croup Score) et de gazométries, a démontré que le mélange hélium-oxygène est une mesure utile permettant souvent ďéviter une réintubation ou une trachéostomie. La justification et les limites de cette thérapie sont discutées.

References

  1. 1.

    Jordon, W.A., Graves, C.L., &Elwyn, R.A. New therapy for postintubation laryngeal edema and tracheitis in children. J.A.M.A.212: 585–588 (1970).

  2. 2.

    Adair, J.C., Ring, W.H., Jordan, W.S., &Elwyn, R.A. Ten-year experience with IPPB in the treatment of acute laryngotracheobronchitis. Anes. and Anal. (Clev.).50: 649–654 (1971).

  3. 3.

    Oh, T.H. &Downes, J.J. Comparison of IPPB and powered nebulizer to administer racemic epinephrine in croup. Abstracts of Scientific Meetings. American Society of Anesthesiologists Annual Meeting, New Orleans (1977).

  4. 4.

    Schuller. D.E. &Birck, H.G. The safety of intubation in croup and epiglottitis: An eight-year follow-up. Laryngoscope:85: 33 (1975).

  5. 5.

    Barach, A.L. The therapeutic use of helium. J.A.M.A.107: 1273–1279 (1936).

  6. 6.

    Downes, J.J. &Raphaely, R.C. Pediatric intensive care. Anesthesiology43: 238–250 (1975).

  7. 7.

    Macintosh, R.,Mushin, W.W., &Epstien, H.G. Helium-oxygen mixture. In:Physics for Anesthetists. Second edition, Oxford Blackwell, pp. 192–195, 250–251 (1958).

  8. 8.

    Lee, T.S., Ohmura, A., Wong, K.C., &Hodges, M.R. Helium-oxygen in treatment of upper airway obstruction. Anesthesiology45: 678–681 (1976).

  9. 9.

    Tatsumo, K., Omai, Y., &Konno, S. Therapeutic use of Helium-Oxygen mixture in CPAP for early weaning from mechanical ventilation after cardiovascular surgery in infants. J. Thor. Cardiovasc. Surg.72: 119–122 (1976).

  10. 10.

    Barnett, T.B. Effects of helium and oxygen mixtures on pulmonary mechanics during airway obstruction. J. Appl. Physiol.22(4) 707–713 (1967).

  11. 11.

    Newth, C.J.L., Levison, H., &Bryan, A.C. The Respiratory status of children with croup. Journal of Pediatrics81: 1068–1073 (1972).

  12. 12.

    Altland, P.D., Brubach, H.F., &Parker, M.G. Effects of inert gases on tolerance of rats to hypoxia. J. Appl. Physiol.24(6): 778–781 (1968).

Download references

Author information

Correspondence to Peter G. Duncan.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Duncan, P.G. Efficacy of helium — oxygen mixtures in the management of severe viral and post-intubation croup. Canad. Anaesth. Soc. J. 26, 206–212 (1979). https://doi.org/10.1007/BF03006983

Download citation

Keywords

  • Tracheal Intubation
  • Patent Ductus Arteriosus
  • Croup
  • Airway Narrowing
  • Artificial Airway