A multicenter, randomized trial of noninvasive ventilation with helium-oxygen mixture in exacerbations of chronic obstructive lung disease

作者：Maggiore Salvatore Maurizio; Richard Jean Christophe M; Abroug Fekri; Diehl Jean Luc; Antonelli Massimo; Sauder Philippe; Mancebo Jordi; Ferrer Miquel; Lellouche Francois; Lecourt Laurent; Beduneau Gaetan; Brochard Laurent^*

来源：Critical Care Medicine, 2010, 38(1): 145-151.

DOI：10.1097/CCM.0b013e3181b78abe

• mechanical ventilation
• heliox
• acute respiratory failure
• chronic obstructive pulmonary disease
• endotracheal intubation

Objective: To assess the effect of a helium-oxygen mixture on intubation rate and clinical outcomes during noninvasive ventilation in acute exacerbation of chronic obstructive pulmonary disease.
Design: Multicenter, prospective, randomized, controlled trial.
Setting: Seven intensive care units.
Patients: A total of 204 patients with known or suspected chronic obstructive pulmonary disease and acute dyspnea, Paco(2)> 45 mm Hg and two among the following factors: pH <7.35, Paco(2) <50 mm Hg, respiratory rate >25/min.
Interventions: Noninvasive ventilation randomly applied with or without helium (inspired oxygen fraction 0.35) via a face mask.
Measurements and Main Results: Duration and complications of NIV and mechanical ventilation, endotracheal intubation, discharge from intensive care unit and hospital, mortality at day 28, adverse and serious adverse events were recorded. Follow-up lasted until 28 days since enrollment. Intubation rate did not significantly differ between groups (24.5% vs. 30.4% with or without helium, p = .35). No difference was observed in terms of improvement of arterial blood gases, dyspnea, and respiratory rate between groups. Duration of noninvasive ventilation, length of stay, 28-day mortality, complications and adverse events were similar, although serious adverse events tended to be lower with helium (10.8% vs. 19.6%, p = .08).
Conclusions. Despite small trends favoring helium, this study did not show a statistical superiority of using helium during NIV to decrease the intubation rate in acute exacerbation of chronic obstructive pulmonary disease. (Crit Care Med 2010; 38:145-151)

• 出版日期2010-1