title: Room air dilution of heliox given by facemask.
abstract: OBJECTIVE
  To measure the extent of dilution of helium-oxygen (heliox) by room air when given via high concentration reservoir mask to spontaneously breathing subjects. Substantial dilution of heliox by room air under these circumstances might alter its physical properties sufficiently to negate any potential clinical benefit in obstructive respiratory failure.
  
  
  METHODS
  Healthy volunteers breathing different concentrations of helium in oxygen via two different masks in a randomised crossover design.
  
  
  METHODS
  Operating theatre in a university hospital.
  
  
  METHODS
  Six healthy volunteers.
  
  
  METHODS
  The concentrations of helium, nitrogen and oxygen were measured in the trachea of each volunteer using a mass spectrometer during normal breathing, hyperventilation and hypoventilation.
  
  
  RESULTS
  During normal breathing of Heliox21 (79% helium) via a standard non-rebreathe reservoir mask, within subject median percentage tracheal helium was 37.2% (range 29.3-52.2%) and nitrogen was 41.7% (27.4-49.4%). Air entrainment was affected by changes in breathing pattern: tracheal nitrogen concentration was greater during hyperventilation (55.4%; range 49.4-63.5%) and less during hypoventilation (33.1%; range 24.6-39.6%, p=0.043). Tracheal nitrogen could be almost completely abolished by administering heliox via a tightly fitting cushioned facemask, even during hyperventilation (2.2%; range 0.6-6.1%, p=0.028).
  
  
  CONCLUSIONS
  Heliox administration via a standard high-concentration reservoir mask leads to significant dilution by room air. For the full potential benefits of heliox to be realised in spontaneously breathing patients, it should be administered via a system that achieves a gas tight seal, with no leaks between the delivery device and the surroundings.
authors: Addenbrooke's Hospital, Division of Anaesthesia, University of Cambridge, CB2 2QQ, Cambridge, UK. tdas2@cam.ac.uk
authors: Thomas D A
authors: TD
authors: Standley
authors: Helen L
authors: HL
authors: Smith
authors: Liam J
authors: LJ
authors: Brennan
authors: Ingrid A
authors: IA
authors: Wilkins
authors: Peter G
authors: PG
authors: Bradley
authors: Casiano
authors: C
authors: Barrera Groba
authors: Andrew J
authors: AJ
authors: Davey
authors: David K
authors: DK
authors: Menon
authors: Daniel W
authors: DW
authors: Wheeler
mesh_terms: D000328:Adult; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D016503:Drug Delivery Systems / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006371:Helium / Q000008:administration & dosage* / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008397:Masks; D010100:Oxygen / Q000008:administration & dosage* / Q000494:pharmacology*; D012119:Respiration / Q000187:drug effects; D013990:Tidal Volume / Q000187:drug effects; D014132:Trachea / Q000187:drug effects*
chemical_list: D006371:Helium; C038949:heliox; D010100:Oxygen