A multicenter, randomized trial of noninvasive ventilation with helium-oxygen mixture in exacerbations of chronic obstructive lung disease.
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.
Maggiore
Salvatore Maurizio
SM
Department of Anesthesiology and Intensive Care, Agostino Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy.
Richard
Jean-Christophe M
JC
Abroug
Fekri
F
Diehl
Jean Luc
JL
Antonelli
Massimo
M
Sauder
Philippe
P
Mancebo
Jordi
J
Ferrer
Miquel
M
Lellouche
Francois
F
Lecourt
Laurent
L
Beduneau
Gaetan
G
Brochard
Laurent
L
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
D006371:Helium; D010100:Oxygen