title: A multicenter, randomized trial of noninvasive ventilation with helium-oxygen mixture in exacerbations of chronic obstructive lung disease.
abstract: OBJECTIVE
  To assess the effect of a helium-oxygen mixture on intubation rate and clinical outcomes during noninvasive ventilation in acute exacerbation of chronic obstructive pulmonary disease.
  
  
  METHODS
  Multicenter, prospective, randomized, controlled trial.
  
  
  METHODS
  Seven intensive care units.
  
  
  METHODS
  A total of 204 patients with known or suspected chronic obstructive pulmonary disease and acute dyspnea, Paco2> 45 mm Hg and two among the following factors: pH <7.35, Paco2 <50 mm Hg, respiratory rate >25/min.
  
  
  METHODS
  Noninvasive ventilation randomly applied with or without helium (inspired oxygen fraction 0.35) via a face mask.
  
  
  RESULTS
  Duration and complications of NIV and mechanical ventilation, endotracheal intubation, discharge from intensive care unit and hospital, mortality at day 28, adverse and serious adverse events were recorded. Follow-up lasted until 28 days since enrollment. Intubation rate did not significantly differ between groups (24.5% vs. 30.4% with or without helium, p = .35). No difference was observed in terms of improvement of arterial blood gases, dyspnea, and respiratory rate between groups. Duration of noninvasive ventilation, length of stay, 28-day mortality, complications and adverse events were similar, although serious adverse events tended to be lower with helium (10.8% vs. 19.6%, p = .08).
  
  
  CONCLUSIONS
  Despite small trends favoring helium, this study did not show a statistical superiority of using helium during NIV to decrease the intubation rate in acute exacerbation of chronic obstructive pulmonary disease.
authors.affiliation: Department of Anesthesiology and Intensive Care, Agostino Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Salvatore Maurizio
authors.initials: SM
authors.lastname: Maggiore
authors.forename: Jean-Christophe M
authors.initials: JC
authors.lastname: Richard
authors.forename: Fekri
authors.initials: F
authors.lastname: Abroug
authors.forename: Jean Luc
authors.initials: JL
authors.lastname: Diehl
authors.forename: Massimo
authors.initials: M
authors.lastname: Antonelli
authors.forename: Philippe
authors.initials: P
authors.lastname: Sauder
authors.forename: Jordi
authors.initials: J
authors.lastname: Mancebo
authors.forename: Miquel
authors.initials: M
authors.lastname: Ferrer
authors.forename: Francois
authors.initials: F
authors.lastname: Lellouche
authors.forename: Laurent
authors.initials: L
authors.lastname: Lecourt
authors.forename: Gaetan
authors.initials: G
authors.lastname: Beduneau
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
mesh_terms: D000368:Aged; D001784:Blood Gas Analysis; D003422:Critical Care / Q000379:methods; D005260:Female; D006371:Helium / Q000627:therapeutic use*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008397:Masks; D008875:Middle Aged; D010100:Oxygen / Q000627:therapeutic use; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000628:therapy*; D011659:Pulmonary Gas Exchange; D012008:Recurrence; D012121:Respiration, Artificial / Q000379:methods; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D006371:Helium; D010100:Oxygen