Abstract
BackgroundProlonged weaning from mechanical ventilation has a major impact on ICU bed occupancy and patient outcome, and has significant cost implications.There is evidence in patients around the period of extubation that helium-oxygen leads to a reduction in the work of breathing. Therefore breathing helium-oxygen during weaning may be a useful adjunct to facilitate weaning. We hypothesised that breathing helium-oxygen would reduce carbon dioxide production during the weaning phase of mechanical ventilation.Materials/patients and methodsWe performed a prospective randomised controlled single blinded cross-over trial on 19 adult intensive care patients without significant airways disease who fulfilled criteria for weaning with CPAP. Patients were randomised to helium-oxygen and air-oxygen delivered during a 2 hour period of CPAP ventilation. Carbon dioxide production (VCO2) was measured using a near patient main stream infrared carbon dioxide sensor and fixed orifice pneumotachograph.ResultsCompared to air-oxygen, helium-oxygen significantly decreased VCO2 production at the end of the 2 hour period of CPAP ventilation; there was a mean difference in CO2 production of 48.9 ml/min (95% CI 18.7-79.2 p = 0.003) between the groups. There were no significant differences in other respiratory and haemodynamic parameters.ConclusionThis study shows that breathing a helium-oxygen mixture during weaning reduces carbon dioxide production. This physiological study supports the need for a clinical trial of helium-oxygen mixture during the weaning phase of mechanical ventilation with duration of weaning as the primary outcome.Trial registrationISRCTN56470948
Highlights
Weaning from mechanical ventilation is estimated to account for up to 40% of the total duration of ventilatory support [1]
Compared to air-oxygen, helium-oxygen significantly decreased VCO2 production at the end of the 2 hour period of continuous positives airway pressure (CPAP) ventilation; there was a mean difference in carbon dioxide (CO2) production of 48.9 ml/min between the groups
This study shows that breathing a helium-oxygen mixture during weaning reduces carbon dioxide production
Summary
Weaning from mechanical ventilation is estimated to account for up to 40% of the total duration of ventilatory support [1]. The process of weaning patients has a major impact on ICU bed occupancy with significant cost implication [2]. Breathing helium leads to a decreased resistance in gas flow, a change from turbulent to laminar flow patterns [6] and a reduction in the work of breathing. A change from turbulent to laminar flow patterns is unnecessary for the reduction in the work of breathing which can occur under fully turbulent flow [7]. Prolonged weaning from mechanical ventilation has a major impact on ICU bed occupancy and patient outcome, and has significant cost implications. There is evidence in patients around the period of extubation that helium-oxygen leads to a reduction in the work of breathing. We hypothesised that breathing helium-oxygen would reduce carbon dioxide production during the weaning phase of mechanical ventilation. Carbon dioxide production (VCO2) was measured using a near patient main stream infrared carbon dioxide sensor and fixed orifice pneumotachograph
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