Elsevier

The Journal of Pediatrics

Volume 147, Issue 6, December 2005, Pages 812-817
The Journal of Pediatrics

Original Article
Noninvasive Therapy with Helium–Oxygen for Severe Bronchiolitis

https://doi.org/10.1016/j.jpeds.2005.07.015Get rights and content

Objective

To determine whether noninvasive therapy using a helium–oxygen mixture reduces the use of positive-pressure ventilation in the treatment of respiratory failure caused by severe bronchiolitis.

Study design

This was a multicenter, randomized, double-blind, placebo-controlled trial that recruited infants in 4 pediatric intensive care units (PICUs). A total of 39 nonintubated infants with severe bronchiolitis caused by respiratory syncytial virus (RSV) were randomly assigned within 8 hours of PICU admission to receive a helium–oxygen mixture (helium group) or an air–oxygen mixture (control group) through an inflatable head hood. The primary study outcome was the requirement for positive pressure mechanical ventilation. Results were compared using Fisher's exact test.

Results

No differences were noted between the control and helium groups with respect to age (1.0 vs 1.1 months), prematurity, or family history of asthma or smoking. Positive pressure ventilation was judged necessary for 4 of the 21 (19.0%) infants in the control group and in 4 of the 18 (22.2%) in the helium group (relative risk = 1.17; 95% confidence interval = 0.34 to 4.01).

Conclusions

This study did not detect any differences between the patients in the helium group and the control group with respect to the rate of positive-pressure ventilation.

Section snippets

Study Design

This was a concealed, randomized trial with blinding of patients, their parents, all caregivers except for respiratory therapists, and data collectors. After parental consent, infants were randomly assigned to receive a helium–oxygen mixture (helium group) or an air–oxygen mixture (control group) through an inflatable head hood. This research project was approved by the institutional review boards of all participating hospitals.

Study Population

All infants under age 9 months and weighing < 10 kg who were

Patient Characteristics

From October 2000 to May 2003, 157 infants were screened for inclusion, and 39 met eligibility criteria. Reasons for nonenrollment included intubation and institution of mechanical ventilation before PICU entry (83), age > 9 months or weight > 10 kg (16), negative RSV test (10), PICU stay > 8 hours (8), uncorrected cyanotic heart disease or cardiac failure (8), unavailable equipment (6), history of a previous bronchiolitis episode (5), parental refusal of consent (4), bronchopulmonary dysplasia

Discussion

This study did not detect any differences between the patients in the helium group and the control group with respect to the rate of positive-pressure ventilation (invasive or noninvasive), the evolution of clinical signs and symptoms, or the duration of the study gas administration. The rate of endotracheal intubation observed in our study population (8/39; 21%) was far below that observed previously (58%) and could not be attributed to a lesser gravity of illness, as suggested by the fact

References (25)

  • W.J. Soong et al.

    Continuous positive airway pressure by nasal prongs in bronchiolitis

    Pediatr Pulmonol

    (1993)
  • F. McNamara et al.

    Nasal CPAP treatment in an infant with respiratory syncytial virus–associated apnea

    Pediatr Pulmonol

    (1997)
  • Cited by (0)

    Supported by Air Liquide Santé International, France, and by the Fonds de la Recherche en Santé du Québec (FRSQ), Québec, Canada.

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