title: Helium-oxygen therapy for infants with bronchiolitis: a randomized controlled trial.
abstract: OBJECTIVE
  To compare nebulized racemic epinephrine delivered by 70% helium and 30% oxygen or 100% oxygen followed by helium-oxygen inhalation therapy via high-flow nasal cannula (HFNC) vs oxygen inhalation via HFNC in the treatment of bronchiolitis.
  
  
  METHODS
  Prospective, randomized, controlled, single-blind trial.
  
  
  METHODS
  This study was conducted from October 1, 2004, through May 31, 2008, in the emergency department of an urban, tertiary care children's hospital. Patients Infants aged 2 to 12 months with a Modified Wood's Clinical Asthma Score (M-WCAS) of 3 or higher.
  
  
  METHODS
  Patients initially received nebulized albuterol treatment driven by 100% oxygen. Patients were randomized to the helium-oxygen or oxygen group and received nebulized racemic epinephrine via a face mask. After nebulization, humidified helium-oxygen or oxygen was delivered by HFNC. After 60 minutes of inhalation therapy, patients with an M-WCAS of 2 or higher received a second delivery of nebulized racemic epinephrine followed by helium-oxygen or oxygen delivered by HFNC. Main Outcome Measure Degree of improvement of M-WCAS for 240 minutes or until emergency department discharge.
  
  
  RESULTS
  Of 69 infants enrolled, 34 were randomized to the helium-oxygen group and 35 to the oxygen group. The mean change in M-WCAS from baseline to 240 minutes or emergency department discharge was 1.84 for the helium-oxygen group compared with 0.31 for the oxygen group (P < .001). The mean M-WCAS was significantly improved for the helium-oxygen group compared with the oxygen group at 60 minutes (P = .005), 120 minutes (P < .001), 180 minutes (P < .001), and 240 minutes (P < .001).
  
  
  CONCLUSIONS
  Nebulized racemic epinephrine delivered by helium-oxygen followed by helium-oxygen inhalation therapy delivered by HFNC was associated with a greater degree of clinical improvement compared with that delivered by oxygen among infants with bronchiolitis. Trial Registration clinicaltrials.gov Identifier: NCT00116584.
authors.affiliation: Division of Pediatric Emergency Medicine, Kosair Children's Hospital, 571 S Floyd St, Ste 300, Louisville, KY 40202, 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: Kendra
authors.initials: K
authors.lastname: Sikes
authors.forename: John
authors.initials: J
authors.lastname: Pendleton
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: Shekhar
authors.initials: S
authors.lastname: Venkataraman
mesh_terms: D000420:Albuterol / Q000008:administration & dosage / Q000627:therapeutic use; D001988:Bronchiolitis / Q000628:therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016009:Chi-Square Distribution; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006371:Helium / Q000627:therapeutic use*; D006801:Humans; D006813:Humidity; D007223:Infant; D008297:Male; D009330:Nebulizers and Vaporizers; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D011446:Prospective Studies; D064705:Racepinephrine; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D006371:Helium; D064705:Racepinephrine; D000420:Albuterol; D004837:Epinephrine