• Skip to main content
  • Skip to secondary menu
  • Skip to primary sidebar
  • Skip to footer

Life in the Fast Lane • LITFL • Medical Blog

Emergency medicine and critical care medical education blog

  • MENU
  • ECG
  • CCC
  • Top 100
  • PODCASTS
  • JOBS
  • TOX
  • PART ONE
  • INTENSIVE
Home | CCC | Heliox

Heliox

by Dr Chris Nickson, last update April 24, 2019

CLASS

  • Heliox is a mixture of helium and oxygen
  • Helium is an inert gas with a significantly lower density (and specific gravity) than room air (1.42g/L for O2 vs 0.17g/L for He)

MECHANISM OF ACTION

  • by substituting helium for nitrogen -> reduction in density of the gas -> reduction in Reynolds number -> more laminar flow
    -> reduces airflow resistance, work of breathing and dynamic hyperinflation

PHARMACEUTICS

  • gas administered via a mask with a reservoir bag or via endotracheal tube
  • supplied at 137 bar as either Heliox (79% He, 21% O2) in white cylinders with white/brown shoulders or as 100% helium in brown cylinders (size C, D, E and G cylinders (410, 1400, 3500 and 7300L nominal capacity respectively)
  • can be used as the driving gas for nebulisation

DOSE

  • helium:oxygen mix of 80:20 or 70:30, which are 1.8 and 1.6 times less dense than pure oxygen, respectively.

INDICATIONS

  • lower airways disorders – e.g. severe asthma, severe COPD, bronchiolitis, bronchiectasis, lung cancer
  • extrathoracic or tracheal obstruction – e.g. croup, epiglottitis, foreign body, tumour, tracheal stenosis, tracheomalacia
  • FRC assessment (helium dilution technique)
  • decompression sickness

ADVERSE EFFECTS

  • expensive (10x the cost of oxygen)
  • lack of availability
  • can’t use on those with a high FiO2 (>0.4)
  • ventilators require recalibration for FiO2 and TV – interferes with valve function
  • requires heated humidified circuits as helium conducts heat 6x faster than nitrogen
  • alteration of vocal pitch
  • may reduce the efficiency of coughing

PHARMACOKINETICS

  • near instantaneous onset an offset
  • eliminated within a few breaths

EVIDENCE

  • anecdotal evidence of avoiding need for intubation in upper airway obstruction
  • little evidence of benefit in lower airways obstructive lung disease – the common theme is that heliox is a temporising measure but is not a treatment

References and Links

Journal articles and textbooks

  • Fink JB. Opportunities and risks of using heliox in your clinical practice. Respir Care. 2006 Jun;51(6):651-60. PMID: 16723042.
  • Gentile MA. Inhaled medical gases: more to breathe than oxygen. Respir Care. 2011 Sep;56(9):1341-57; discussion 1357-9. PMID: 21944684.
  • Hess DR, Fink JB, Venkataraman ST, Kim IK, Myers TR, Tano BD. The history and physics of heliox. Respir Care. 2006 Jun;51(6):608-12. PMID: 16723037
  • Kim IK, Saville AL, Sikes KL, Corcoran TE. Heliox-driven albuterol nebulization for asthma exacerbations: an overview. Respir Care. 2006 Jun;51(6):613-8. PMID: 16723038.
  • McGarvey JM, Pollack CV. Heliox in airway management. Emerg Med Clin North Am. 2008 Nov;26(4):905-20, viii. Review. PMID: 19059090.
  • Reuben AD, Harris AR. Heliox for asthma in the emergency department: a review of the literature. Emerg Med J. 2004 Mar;21(2):131-5. PMC1726290.
  • Vorwerk C, Coats T. Heliox for croup in children. Cochrane Database Syst Rev. 2010 Feb 17;(2):CD006822. PMID: 20166089.
  • Wigmore T, Stachowski E. A review of the use of heliox in the critically ill. Crit Care Resusc. 2006 Mar;8(1):64-72. PMID: 16536724.

CCC 700 6

Critical Care

Compendium

…more CCC

Share this:

  • Facebook
  • Twitter
  • LinkedIn
  • Print

Related

About Dr Chris Nickson

An oslerphile emergency physician and intensivist suffering from a bad case of knowledge dipsosis. Key areas of interest include: the ED-ICU interface, toxicology, simulation and the free open-access meducation (FOAM) revolution. @Twitter | INTENSIVE| SMACC

Reader Interactions

Leave a Reply Cancel reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Primary Sidebar

  • Twitter
  • Facebook
  • Vimeo
  • LinkedIn
  • Twitter
  • Twitter
  • RSS Feed
ECG Mastery

Recent Posts

Are the Critically Ill Actually Hungry?

Mastering Intensive Care 049 with Hugh Montgomery

Road to Resus 1: Pre-hospital Resuscitation

Mastering Intensive Care 048 with Laura Rock

Adult CXR Cases 002

Footer

RSS FEED  LITFL posts by EMAIL or RSS

RSS FEED  LITFL Review by EMAIL or RSS

RSS FEED  FFFF by EMAIL or RSS

#FOAMed Medical Education Resources by LITFL is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Based on a work at https://litfl.com

  • Twitter
  • Vimeo
  • Facebook
  • LinkedIn
  • Twitter
  • Twitter

Authors • Blog • Contact • Disclaimer

2018 Launch

  • 22,697,820 visitors

Copyright © 2019 · Powered by vocortex and iSimulate