title: Helium/oxygen-driven albuterol nebulization in the treatment of children with moderate to severe asthma exacerbations: a randomized, controlled trial.
abstract: BACKGROUND
  Helium and oxygen mixtures (heliox) increase both pulmonary aerosol delivery and gas delivery relative to oxygen. We aimed to compare the effectiveness of a 70%:30% helium/oxygen (heliox)-driven continuous aerosol delivery versus 100% oxygen-driven delivery in the treatment of asthmatic children with moderate to severe exacerbations.
  
  
  METHODS
  We enrolled 30 children aged 2 to 18 years who presented to an urban, pediatric emergency department (ED) with moderate to severe asthma as defined by a pulmonary index (PI) score of > or =8. PI scores can range from 0 to 15. In this randomized, controlled, single-blind trial conducted in a convenience sample of children, all patients in the trial received an initial nebulized albuterol (5 mg) treatment driven by 100% oxygen and a dose of oral prednisone or prednisolone. Subsequently, patients were randomly assigned to receive continuously nebulized albuterol (15 mg/hour) delivered by either heliox or oxygen using a nonrebreathing face mask. The primary outcome measure was degree of improvement as assessed in blinded video-recorded PI scores over 240 minutes (at 30-minute intervals for the first 3 hours) or until ED discharge (if <240 minutes).
  
  
  RESULTS
  The mean change in PI score from baseline to 240 minutes or ED discharge was 6.67 for the heliox group compared with 3.33 for the oxygen group. Eleven (73%) patients in the heliox group were discharged from the hospital in <12 hours compared with 5 (33%) patients in the conventional group.
  
  
  CONCLUSIONS
  Continuously nebulized albuterol delivered by heliox was associated with a greater degree of clinical improvement compared with that delivered by oxygen among children with moderate to severe asthma exacerbations.
authors.affiliation: Division of Pediatric Emergency Medicine, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA. in.kim@louisville.edu
authors.forename: In K
authors.initials: IK
authors.lastname: Kim
authors.forename: Erin
authors.initials: E
authors.lastname: Phrampus
authors.forename: Shekhar
authors.initials: S
authors.lastname: Venkataraman
authors.forename: Raymond
authors.initials: R
authors.lastname: Pitetti
authors.forename: Al
authors.initials: A
authors.lastname: Saville
authors.forename: Timothy
authors.initials: T
authors.lastname: Corcoran
authors.forename: Ed
authors.initials: E
authors.lastname: Gracely
authors.forename: Nicole
authors.initials: N
authors.lastname: Funt
authors.forename: Ann
authors.initials: A
authors.lastname: Thompson
mesh_terms: D000208:Acute Disease; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage*; D000336:Aerosols; D000420:Albuterol / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D002648:Child; D004636:Emergency Service, Hospital; D005260:Female; D006371:Helium; D006801:Humans; D008297:Male; D009330:Nebulizers and Vaporizers; D010092:Oximetry; D010100:Oxygen; D012129:Respiratory Function Tests; D016037:Single-Blind Method
chemical_list: D000318:Adrenergic beta-Agonists; D000336:Aerosols; D001993:Bronchodilator Agents; D006371:Helium; C038949:heliox; D000420:Albuterol; D010100:Oxygen