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Intensive Care Medicine

Published in:

01-10-2003 | Original

Helium-oxygen reduces work of breathing in mechanically ventilated patients with chronic obstructive pulmonary disease

Authors: Marc Gainnier, Jean-Michel Arnal, Patrick Gerbeaux, Stéphane Donati, Laurent Papazian, Jean-Marie Sainty

Published in: Intensive Care Medicine | Issue 10/2003

Abstract

Objective

To evaluate whether helium-oxygen mixture reduces inspiratory work of breathing (WOB) in sedated, paralyzed, and mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (COPD).

Design and setting

Open, prospective, randomized, crossover study in the medical intensive care unit in a university hospital.

Patients and participants

23 patients admitted for acute exacerbation of COPD and mechanically ventilated.

Measurements

Total WOB (WOBt), elastic WOB (WOBel), resistive WOB (WOBres), and WOB due to PEEPi (WOBPeepi) were measured. Static intrinsic positive end expiratory pressure (PEEPi), static compliance (Crs), inspiratory resistance (Rins), inspiratory (tinsp) and expiratory time constant (texp) were also measured. These variables were compared between air-oxygen and helium-oxygen mixtures.

Results

WOBt significantly decreased with helium-oxygen (2.34±1.04 to 1.85±1.01 J/l, p<0.001). This reduction was significant for WOBel (1.02±0.61 J/l to 0.87±0.47, p<0.01), WOBPeepi (0.77±0.38 J/l to 0.54±0.38, p<0.001), and WOBres (0.55±0.19 J/l to 0.44±0.24, p<0.05). PEEPi, Rins, tinsp and texp significantly decreased. Crs was unchanged.

Conclusions

Helium-oxygen mixture decreases WOB in mechanically ventilated COPD patients. Helium-oxygen mixture could be useful to reduce the burden of ventilation.

Similowski T, Derenne J, Milic-Emili J (1996) In: Derenne JP, Whitelaw WA, Similowski, T (ed) Acute respiratory failure in chronic obstructive pulmonary disease. Dekker, New York, pp 23–46

Coussa M, Guérin C, Eissa T, Corbeil C, Chassé M, Braidy J, Mata N, Milic-Emili J (1993) Partitioning of work of breathing in mechanically ventilated COPD patients. J Appl Physiol 75:1711–1719

Jaber S, Fodil R, Carlucci A, Boussassar M, Pigeot J, Lemaire F, Harf A, Lofaso F, Isabey D, Brochard L (2000) Noninvasive ventilation with helium-oxygen in acute exacerbation of chronic obstructive pulmonary disease. Am J Respir Crit Care 161:1191–1200PubMed

Jolliet P, Tassaux D, Thouret J, Chevrolet J (1999) Beneficial effects of helium-oxygen versus air-oxygen non invasive pressure support in patient with decompensated chronic obstructive pulmonary disease. Crit Care Med 27:2422–2429PubMed

Tassaux D, Jolliet P, Roeseler J, Chevrolet J (2000) Effect of helium-oxygen on intrinsic positive end-expiratory pressure in intubated and mechanically ventilated patients with severe chronic obstructive pulmonary disease. Crit Care Med 28:2721–2728PubMed

American Thoracic Society (1995) Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 152 [Suppl]:S77–S121

Pauwels R, Buist A, Calverley P, Jenkins C, Hurd S (2001) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med 163:1256–1276PubMed

Tassaux D, Jolliet P, Thouret J, Roeselet J, Dorne R, Chevrolet J (1999) Calibration of seven ICU ventilators for mechanical ventilation with helium-oxygen mixture. Am J Respir Crit Care Med 160:22–32–PubMed

Oppenheim-Eden A, Cohen Y, Weissman C, Pizov R (2001) The effect of helium on ventilator performance. Study of five ventilators and a bedside Pitot tube spirometer. Chest 120:582–588CrossRefPubMed

10.

Gottfried S, Reissman H, Ranieri M (1992) A simple method for the measurement of intrinsic positive end-expiratory pressure during controlled and assisted modes of mechanical ventilation. Crit Care Med 20:621–629

11.

Rossi A (1999) In: Milic-Emili J, Lucangelo U, Pesenti A, Zin W (ed) Basics of respiratory mechanics and artificial ventilation. Springer, Berlin Heidelberg New York, pp 81–85

12.

Tobin M, Van De Graff W (1994) In: Tobin, MJ (ed) Principles and practice of mechanical ventilation. McGraw Hill, New York, pp 967–2003

13.

Agostoni E, Campbell E, Freedman S (1970) In: Campbell E, Agostoni E, Davis, J (ed) The respiratory muscles: mechanics and neural control. Saunders, Philadelphia, pp 115–190

14.

Milic-Emili J, Rocca E, D'Angelo E (1999) In: Milic-Emili J, Lucangelo U, Pesenti A, Zin WA (ed) Basics of respiratory mechanics and artificial ventilation. Springer, Berlin Heidelberg New York, 165–175

15.

Muller N, Zamel N (1981) Pneumotachograph calibration for inspiratory and expiratory flows during HeO2 breathing. J Appl Physiol 51:1038–1041PubMed

16.

Guérin C, Coussa M, Eissa N, Corbeil C, Chassé M, Braidy J, Matar N, Milic-Emili J (1993) Lung and chest wall mechanics in mechanically ventilated COPD patients. J Appl Physiol 74:1570–1580PubMed

17.

Guérin C, Milic-Emili J, Fournier G (2000) Effect of PEEP on work of breathing in mechanically ventilated COPD patients. Intensive Care Med 26:1207–1214PubMed

18.

Gladwin M, Pierson D (1998) Mechanical ventilation of the patient with severe chronic obstructive pulmonary disease. Intensive Care Med 24:898–910

19.

Papamoschou D (1995) Theoretical validation of the respiratory benefits of helium-oxygen mixtures. Respir Physiol 99:183–190CrossRefPubMed

20.

Rossi A, Gottfried S, Zocchi L, Higgs B, Lennox S, Calverley P, Begin P, Grassino A, Milic-Emili J (1985) Measurement of static compliance of the total respiratory system in patients with acute respiratory failure during mechanical ventilation. The effect of intrinsic positive end-expiratory pressure. Am Rev Respir Dis 131:672–677PubMed

21.

Broseghini C, Brandolese R, Poggi R, Polese G, Manzin E, Milic-Emili J, Rossi A (1988) Respiratory mechanics during the first day of mechanical ventilation in patients with pulmonary oedema and chronic airway obstruction. Am Rev Respir Dis 138:355–361PubMed

22.

D'Angelo E, Milic-Emili J, Marazzini L (1996) Effects of bronchomotor tone and gas density on time dependence of forced expiratory vital capacity manoeuver. Am J Respir Crit Care Med 154:1318–1322

23.

Barnas G, Yoshino K, Loring S, Mead J (1987) Impedance and relative displacements of relaxed chest wall to 4 Hz. J Appl Physiol 62:71–81PubMed

24.

Maltais F, Reissman H, Navalesi P, Hernandez P, Gursahaney A, Ranieri M, Sovilj M, Gottfried S (1994) Comparason of static and dynamic measurements of intrinsic PEEP in mechanically ventilated patients. Am J Respir Crit Care Med 150:1318–1324PubMed

Title: Helium-oxygen reduces work of breathing in mechanically ventilated patients with chronic obstructive pulmonary disease
Authors: Marc Gainnier
Jean-Michel Arnal
Patrick Gerbeaux
Stéphane Donati
Laurent Papazian
Jean-Marie Sainty
Publication date: 01-10-2003
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 10/2003
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-003-1911-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Helium-oxygen reduces work of breathing in mechanically ventilated patients with chronic obstructive pulmonary disease

Abstract

Objective

Design and setting

Patients and participants

Measurements

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design and setting

Patients and participants

Measurements

Results

Conclusions

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