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Helium/oxygen-driven albuterol nebulization in the management of children with status asthmaticus: A randomized, placebo-controlled trial*

Bigham, Michael T. MD; Jacobs, Brian R. MD; Monaco, Marie A. BSN, CCRN; Brilli, Richard J. MD; Wells, Dan RRT; Conway, Edward M. RRT; Pettinichi, Scott RRT; Wheeler, Derek S. MD

Pediatric Critical Care Medicine: May 2010 - Volume 11 - Issue 3 - pp 356-361
doi: 10.1097/PCC.0b013e3181c5163f
Continuing Medical Education Articles

Objectives: We investigated the effect of heliox-powered albuterol therapy on hospital length of stay and clinical status in children with moderate to severe status asthmaticus.

Design: Prospective, randomized, placebo-controlled trial.

Setting: Twenty-five-bed pediatric intensive care unit at an academic children’s medical center.

Patients: Forty-two children (2-21 yrs of age) with moderate to severe status asthmaticus.

Interventions: Patients were randomized to receive either heliox-powered nebulized albuterol or air/oxygen-powered nebulized albuterol (placebo) until they were transitioned to albuterol delivered by a metered dose inhaler.

Measurements and Main Results: Clinical asthma scores were recorded on enrollment and every 4 hrs thereafter. Patients in the heliox group (n = 22) and the control group (n = 20) had similar ages (mean ± sem: 88 ± 9.9 vs. 98 ± 11.1 months, respectively; p = .51), time to study enrollment (618 ± 70.4 vs. 597 ± 84.1 mins, respectively; p = .72), and clinical asthma scores at study entry (5.9 ± 0.2 vs. 5.7 ± 0.3, respectively; p = .72). There were no significant differences between groups in time to eligibility to hospital discharge (66.2 ± 8.7 vs. 63.4 ± 8.6 hrs, respectively; p = .61), time to clinical asthma score <3 (22 ± 2.8 vs. 21.2 ± 5.3 hrs, respectively; p = .27), or time to eligibility for intensive care unit discharge (34.4 ± 6.8 vs. 33.3 ± 8.2 hrs, respectively; p = .64). There were no significant differences in adverse events between groups.

Conclusions: Despite the previously demonstrated effects of heliox on improved aerosol particle delivery into the distal airways, heliox-powered nebulized albuterol therapy for children admitted to the hospital with moderate to severe status asthmaticus does not shorten hospital length of stay or hasten rates of clinical improvement when compared with air/oxygen-powered nebulized albuterol.

Clinical Assistant Professor of Pediatrics (MTB), Division of Critical Care Medicine, Akron Children’s Hospital, Akron, OH; Medical Director (MTB), Pediatric Transport, Akron Children’s Hospital, Akron, OH; Professor (BRJ), Pediatrics, Children’s National Medical Center, Washington, DC; Vice President and Chief Medical Information Officer (BRJ), Children’s National Medical Center, Washington, DC; Research Nurse III (MAM), Cincinnati Children’s Medical Center, Cincinnati, OH; Chief Medical Officer (RJB), Nationwide Children’s Hospital, Cincinnati, OH; Clinical Manager (DW), Pediatric Intensive Care Unit, Cincinnati Children’s Hospital, Cincinnati, OH; Clinical RT Manager (EMC), Cincinnati Children’s Hospital, Cincinnati, OH; Senior Clinical Director (SP), Division of Respiratory Care, Cincinnati Children’s Hospital, Cincinnati, OH; and Clinical Director (DSW), Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.

Supported by a grant from Praxair, Inc.

For information regarding this article, E-mail: Derek.wheeler@cchmc.org

©2010The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies