Helium-oxygen versus air-oxygen noninvasive pressure support in decompensated chronic obstructive disease: A prospective, multicenter study.
OBJECTIVE
To study whether noninvasive pressure support ventilation (NIPSV) with helium/oxygen (He/oxygen), which can reduce dyspnea, PaCO2, and work of breathing more than NIPSV with air/oxygen in decompensated chronic obstructive pulmonary disease, could have beneficial consequences on outcome and hospitalization costs.


METHODS
Prospective, randomized, multicenter study.


METHODS
Intensive care units of three tertiary care university hospitals.


METHODS
All patients with chronic obstructive pulmonary disease admitted to the intensive care units for NIPSV during a 24-month period.


METHODS
Patients were randomized to NIPSV with air/oxygen or He/oxygen. NIPSV settings, number of daily trials, decision to intubate, and intensive care unit and hospital discharge criteria followed standard practice guidelines.


RESULTS
A total of 123 patients (male/female ratio, 71:52; age, 71 +/- 10 yrs, Acute Physiology and Chronic Health Evaluation II, 17 +/- 4) were included. Intubation rate (air/oxygen 20% vs. He/oxygen 13%) and length of stay in the intensive care unit (air/oxygen 6.2 +/- 5.6 vs. He/oxygen 5.1 +/- 4 days) were comparable. The post-intensive care unit hospital stay was lower with He/oxygen (air/oxygen 19 +/- 12 vs. He/oxygen 13 +/- 6 days, p < .002). Cost of NIPSV gases was higher with He/oxygen, but total hospitalization costs were lower by $3,348 per patient with He/oxygen. No complications were associated with the use of He/oxygen.


CONCLUSIONS
He/oxygen did not significantly reduce intubation rate or intensive care unit stay, but hospital stay was shorter and total costs were lower. He/oxygen NIPSV can be safely administered and could prove to be a cost-effective strategy.
Jolliet
Philippe
P
Medical Intensive Care Division, University Hospital, Geneva, Switzerland.
Tassaux
Didier
D
Roeseler
Jean
J
Burdet
Luc
L
Broccard
Alain
A
D'Hoore
William
W
Borst
François
F
Reynaert
Marc
M
Schaller
Marie-Denise
MD
Chevrolet
Jean-Claude
JC
D018806:APACHE; D000368:Aged; D001784:Blood Gas Analysis; D003362:Cost-Benefit Analysis; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006371:Helium / Q000191:economics / Q000627:therapeutic use*; D017721:Hospital Costs / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000191:economics / Q000627:therapeutic use*; D010102:Oxygen Inhalation Therapy / Q000191:economics / Q000379:methods*; D011175:Positive-Pressure Respiration / Q000191:economics / Q000379:methods*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012449:Safety; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome; D014939:Work of Breathing
D006371:Helium; C038949:heliox; D010100:Oxygen