Nasal CPAP With 'Heliox' Helps Spare Preemies From Ventilators

In preterm infants with respiratory distress syndrome, using heliox - 80% helium and 20% oxygen - with nasal CPAP (continuous positive airway pressure) reduces the need for mechanical ventilation, Italian researchers say.

Dr. Mariarosa Colnaghi from University of Milan and colleagues pointed out online today in Pediatrics that others have suggested heliox might improve the effectiveness of noninvasive ventilation in adults and children, but there's very little data on newborns.

They note that because helium is so much less dense than air, it can reduce turbulent flow in the airways and reduce the resistance to flow. As a result, less pressure is needed to move gases to the periphery of the lungs, and gas exchange in the distal airways is improved.

In a randomized pilot study in preterm infants with respiratory distress syndrome (RDS) receiving nasal CPAP treatment, the researchers compared heliox (BOC Medical, The Linde Group, Munich, Germany) to medical air.

In the intervention group, babies received heliox for 12 hours. Beyond that, anyone still requiring nasal CPAP was switched to medical air.

The risk of intubation for mechanical ventilation was significantly lower with heliox than with medical air (14.8% vs 45.8%; p=0.029), the authors reported. Also, the proportion of babies needing surfactant was significantly lower in the heliox group (11.1% vs 43.5%; p=0.021).

The mean total duration of nasal CPAP was 26 days in the heliox group and 33 days in the medical air control group (P=0.681). Complications of prematurity did not differ between the groups, and there were no reported side effects.
The benefits of heliox on these primary outcomes persisted after adjusting for other treatment, gestational age, gender, and other covariates, according to the investigators.

This was a small, unblinded pilot study, the authors acknowledge. Now, they say, "Additional studies are needed to confirm our data and verify whether heliox therapy is able to reduce the incidence of complications of prematurity, such as bronchopulmonary dysplasia."