Used for treatment of some types of airway obstructions. Also, to reduce the work of breathing, aid in the delivery of the oxygen molecule to the alveoli, and reduce airway resistance
How it works:
Given the low density of helium, Heliox is more likely to exhibit laminar gas flow; requiring a lower pressure gradient to advance gas flow beyond an airway obstruction. Heliox may act to reduce turbulent airflow in obstructed airways, consequently reducing airway resistance
It is no longer effective after FiO2 is above 40% so, greater than 40% O2 are contraindicated
Types of patients you might suggest heliox for are:
Croup
Status Asthmaticus
Post extubation stridor
The ways we administer Heliox:
Non-rebreather (preferred)
Attach the non-rebreather directly to the flowmeter attached to the heliox regulator
Run flow at minimum of 10LPM to keep the bag at least 1/3 to 1/2 inflated during inspiration.
If patient requires additional FiO2, 100% O2 will be bled in via a T-piece adapter before the analyzer from a 100% O2 source. Do not use a blender except in the ED.
Cool mist aerosol mask
Attach cool mist set-up directly to the flowmeter on the heliox regulator
High flow nasal cannula
Adapt the oxygen tubing directly to the flowmeter on the heliox regulator using heliox to drive the flow
Flow rate should be geared towards patient inspiratory flow demand. This can be evaluated by noting the CPAP roar heard between inspiratory and expiratory flows.
If patient requires additional FiO2, 100% O2 will be bled in via white manifold via a 100% O2 source. Do not use a blender except in the ED.
Servo-I (see Heliox with Servo page)
Post Therapeutic Interventions Assessment:
Once the patient has been placed on Heliox, or any changes have been made to the Heliox (flow, concentration, etc), you will need do a reassessment
Things to look for
Any adverse effect
Bronchospasm
EKG Arrhythmias
Seizure activity
Rash
Decreased LOC
Decreased perfusion
Any clinical changes from prior assessment
Respiratory Rate
Heart Rate and Rhythm
Breath sounds
Cough effectiveness
Blood pressure
Tidal volumes
Peak flows
Increased or decreased irritability and/or work of breathing
Lack of response to therapy
If lack of response is present assess for need of discontinued therapy, initiation of new therapy, or modification of current therapy
Troubleshooting
Is the system complete? Is any part disconnected?
Is tank pressure greater than 200 PSI?
Is the flow high enough to meet or exceed the patient total flow demand?
Is the required FiO2 greater than 40%?
Is there only two gases in the system, ie: oxygen and helium and not nitrogen from an air source.
General
Orders
Ordered under “heliox”. The order must include a concentration and delivery method
Documentation
Must be documented under “specialty gases” with assessment Q4 hours (Compass)
Cleaning
Label the tank with the remaining psi and disconnect the regulator
Regulator should be wiped down with Sani wipes and stored in the PICU par bin (or locked cabinet for vent regulators-call charge)