Heliox for Pediatric Critical Asthma: A Multicenter,Retrospective,Registry-Based Descriptive Study

Abstract

Background:

In cases of critical asthma (CA), heliox may be applied as an adjunctive rescue therapy to avoid invasive mechanical ventilation (MV), improve deposition of aerosolized medications, and enhance laminar airflow through obstructed airways. Using the Pediatric Health Information System (PHIS) registry, we evaluate heliox prescribing and explored for differences in MV rates and hospital length of stay (LOS) among children with and without heliox exposure.

Methods:

We performed a retrospective cohort study using PHIS data from 42 pediatric intensive care units among children 5-17 years of age admitted for CA from 2010 through 2019. Primary outcomes were heliox prescribing rates and trends. Secondary outcomes were invasive MV rates and LOS assessed in a subgroup of children receiving ≥ 1 adjunctive intervention(s).

Results:

Of the 19,780 studied, heliox was prescribed in 12.5% and linearly declined from 16.1% in 2010 to 5.6% in 2019. The overall MV rate was 12.8% and was lower in subjects receiving heliox alone (4.9%) compared to heliox plus alternative adjunctive therapies [31.2%] or children receiving non-heliox adjunctive therapies [22.1%], P < .01). Accounting for MV, no difference in LOS was observed. In exploratory adjusted models, MV free hospitalization was associated with heliox-only exposure (OR: 0.33, 95% CI: 0.17-0.63, P < .01) and exposure to multiple adjunctive therapies was associated with MV (OR: 2.48, 95% CI: 1.56-3.94, P < .01).

Conclusions:

In this multicenter retrospective study from 42 children’s hospitals, heliox prescribing for CA declined over the last decade. Subjects receiving multiple adjunctive therapies more commonly required invasive MV perhaps indicating a greater severity of illness. At this time, prospective trials needed to identify the role of heliox for pediatric CA.

Keywords

heliox critical asthma near-fatal asthma status asthmaticus pediatric intensive care unit mechanical ventilation mortality invasive ventilation

Get full access to this article

View all access options for this article.

References

United States Center for Disease Control and Prevention. Most recent asthma data: national current asthma prevalence 2018. Accessed December 16, 2020. https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm

Fassl

Nkoy

Stone

, et al. The joint commission children’s asthma care quality measures and asthma readmissions. Pediatrics. 2012;130(3):482–491.

Akinbami

Moorman

Garbe

Sondik

. Status of childhood asthma in the United States, 1980-2007. Pediatrics. 2009;123(Suppl 3):S131–S145.

Shanley

Lin

Flores

. Factors associated with length of stay for pediatric asthma hospitalizations. J Asthma. 2015;52(5):471–477.

Nunes

Pereira

Morais-Almeida

. Asthma costs and social impact. Asthma Res Pract. 2017;6(3):1.

Hoch

Kattan

Szefler

. Challenges in managing difficult-to-treat asthma in children: stop, look, and listen. Pediatr Pulmonol. 2020;55(3):791–894.

Laher

Buchanan

. Mechanically ventilating the severe asthmatic. J Intensive Care Med. 2018;33(9):491–501.

Leatherman

. Mechanical ventilation for severe asthma. Chest. 2015;147(6):1671–1680.

Bratton

Newth

CJL

Zuppa

, et al. Critical care for pediatric asthma: wide variability and challenges for study. Pediatr Crit Care Med. 2012;13(4):407–414.

10.

Rehder

. Adjunct therapies for refractory status asthmaticus in children. Respir Care. 2017;62(6):849–865.

11.

Frazier

Cheifetz

. The role of heliox in paediatric respiratory disease. Paediatr Respir Rev. 2010;11(1):46–53.

12.

Truebel

Wuester

Boehme

, et al. A proof-of-concept trial of HELIOX with different fractions of helium in a human study modeling upper airway obstruction. Eur J Appl Physiol. 2019;119(5):1253–1260.

13.

Gauthier

Ray

Wenzel

. Evolving concepts of asthma. Am J Respir Crit Care Med. 2015;192(6):660–668.

14.

Gupta

Cheifetz

. Heliox administration in the pediatric intensive care unit: an evidence-based review. Pediatr Crit Care Med. 2005;6(2):204–211.

15.

Rodrigo

Castro-Rodriguez

. Heliox-driven β2-agonists nebulization for children and adults with acute asthma: a systematic review with meta-analysis. Ann Allergy Asthma Immunol. 2014;112(1):29–34.

16.

Hurford

Cheifetz

. Respiratory controversies in the critical care setting. Should heliox be used for mechanically ventilated patients? Respir Care. 2007;52(5):582–591.

17.

Gupta

Grayck

Cheifetz

. Heliox administration during high-frequency jet ventilation augments carbon dioxide clearance. Respir Care. 2004;49(9):1038–1044.

18.

Katz

Gentile

Craig

Quick

Cheifitz

. Heliox does not affect gas exchange during high-frequency oscillatory ventilation if tidal volume is held constant. Crit Care Med. 2003;31(7):2006–2009.

19.

Katz

Gentile

Craig

Quick

Meliones

Cheifitz

. Heliox improves gas exchange during high-frequency ventilation in a pediatric model of acute lung injury. Am J Respir Crit Care Med. 2001;164(2):260–264.

20.

Kass

Terregina

. The effect of heliox in acute severe asthma: a randomized controlled trial. Chest. 1999;116(2):296–300.

21.

Kudukis

Manthous

Schmidt

Hall

Wylam

. Inhaled helium-oxygen revisited: effect of inhaled helium-oxygen during the treatment of status asthmaticus in children. J Pediatr. 1997;130(2):217–224.

22.

Rose

Panacek

Miller

. Prospective randomized trial of heliox-driven continuous nebulizers in the treatment of asthma in the emergency department. J Emerg Med. 2002;22(2):133–137.

23.

Dilley

Sheehan

Petty

Gaffin

Hauptman

Phiptanakul

. Comparison of treatment modalities for inpatient asthma exacerbations among US pediatric hospitals. J Allergy Clin Immunol Pract. 2017;5(3):855–857.

24.

Carter

Webb

Moffitt

. Evaluation of heliox in children hospitalized with acute severe asthma: a randomized crossover trial. Chest. 1996;109(5):1256–1261.

25.

Kim

Phrampus

Venkataraman

, et al. Helium/oxygen-driven albuterol nebulization in the treatment of children with moderate to severe asthma exacerbations: a randomized, control trial. Pediatrics. 2005;116(5):1127–1133.

26.

Bigham

Jacobs

Monaco

, et al. Helium/oxygen-drive albuterol nebulization in the management of children with status asthmaticus: a randomized, placebo-controlled trial. Pediatr Crit Care Med. 2010;11(3):356–361.

27.

Rivera

Kim

Stewart

Minasyan

Brown

. Albuterol nebulized in heliox in the initial ED treatment of pediatric asthma: a blinded, randomized controlled trial. Am J Emerg Med. 2006;24(1):38–42.

28.

Ryan

Son

Roddy

, et al. Pediatric asthma severity scores distinguish suitable inpatient level of care for children admitted for status asthmaticus. J Asthma. 2021;58(2):151–159.

29.

Bekhof

Reimink

Brand

PLP

. Systematic review: insufficient validation of clinical scores for the assessment of acute dyspnea in wheezing children. Paediatr Respir Rev. 2014;15(1):98–112.

30.

Rodrigo

Pollack

Rodrigo

Rowe

. Heliox for non-intubated acute asthma patients. Cochrane Database Syst Rev. 2003;(4);CD002884.

31.

Rampersad

Wilkins

Egan

. Outcomes of paediatric critical care asthma patients. J Paediatr Child Health. 2018;54(6):633–637.

32.

United States Geological Society. National Minerals Information Center. Helium statistics and information. Accessed October 10, 2020. https://www.usgs.gov/centers/nmic/helium-statistics-and-information

33.

Shibata

Khemani

Markovitz

. Patient origin is associated with duration of endotracheal intubation and PICU length of stay for children with status asthmaticus. J Intensive Care Med. 2014;29(3):154–159.

34.

Carroll

Smith

Collins

Bhandri

Schramm

Zucker

. Endotracheal intubation and pediatric status asthmaticus: site of original care affects treatments. Pediatr Crit Care Med. 2007;8(2):91–95.

35.

Newth

Meert

Clark

, et al. Fatal and near-fatal asthma in children: the critical care perspective. J Pediatr. 2012;161(2):214–221.e3.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.32 MB