Use Of Heliox Research Articles

Outcomes of heliox use in children with respiratory compromise: A 10-year single institution experience.

Heliox, a mixture of helium and oxygen, has been shown to improve laminar airflow and decrease airway resistance in children. This study aims to describe the outcomes of heliox use in children with respiratory compromise and to identify variables associated with a need for airway surgical intervention. A retrospective cohort study of patients who received heliox between 2012 and 2022 at a tertiary care children's hospital. A hundred and thirty-eight heliox treatments were recorded in 119 children. Twelve patients were excluded. Most (n = 100, 84%) patients had significant comorbidities. On average, patients spent a cumulative mean of 94 ± 187 h on heliox therapy per hospital admission. Patients with croup or asthma without known airway pathology presented at an older age than patients with other indications for heliox therapy (4.0 ± 4.7 vs. 2.2 ± 3.6 years, p = 0.04) and were significantly less likely to have background diseases (n = 14, 52% vs. n = 74, 93%, p < 0.0001). Overall, 51 (47.7%) patients were recommended tracheostomy placement, airway reconstruction, or palliative care. Cumulative use of heliox for more than 47 h was associated with an increased risk of needing tracheostomy or airway reconstruction (odds ratio 6.2, 95% confidence intervals 2.56-14.13, p < 0.0001). In multivariable regression analysis, neuromuscular disease, intracranial neuropathology, and cumulative time of heliox were associated with a need for definitive airway intervention. Heliox may be used as a temporizing agent in children with upper airway obstruction. The effectiveness of heliox use for more than 47 h in children, especially in the presence of neuromuscular disease and intracranial neuropathology should be reconsidered.Level of evidence: 4.

Respiratory Care Management of COPD Exacerbations.

A COPD exacerbation is characterized by an increase in symptoms such as dyspnea, cough, and sputum production that worsens over a period of 2 weeks. Exacerbations are common. Respiratory therapists and physicians in an acute care setting often treat these patients. Targeted O2 therapy improves outcomes and should be titrated to an SpO2 of 88-92%. Arterial blood gases remain the standard approach to assessing gas exchange in patients with COPD exacerbation. The limitations of arterial blood gas surrogates (pulse oximetry, capnography, transcutaneous monitoring, peripheral venous blood gases) should be appreciated so that they can be used wisely. Inhaled short-acting bronchodilators can be provided by nebulizer (jet or mesh), pressurized metered-dose inhaler (pMDI), pMDI with spacer or valved holding chamber, soft mist inhaler, or dry powder inhaler. The available evidence for the use of heliox for COPD exacerbation is weak. Noninvasive ventilation (NIV) is standard therapy for patients who present with COPD exacerbation and is supported by clinical practice guidelines. Robust high-level evidence with patient important outcomes is lacking for the use of high-flow nasal cannula in patients with COPD exacerbation. Management of auto-PEEP is the priority in mechanically ventilated patients with COPD. This is achieved by reducing airway resistance and decreasing minute ventilation. Trigger asynchrony and cycle asynchrony are addressed to improve patient-ventilator interaction. Patients with COPD should be extubated to NIV. Additional high-level evidence is needed before widespread use of extracorporeal CO2 removal. Care coordination can improve the effectiveness of care for patients with COPD exacerbation. Evidence-based practices improve outcomes in patients with COPD exacerbation.

Apport de l’hélium dans la réhabilitation respiratoire de patients BPCO sévères

Out of the 53 patients included, 45 were randomly assigned to two groups: Heliox (n= 23) and Air (n= 22). Patients were assessed with spirometry under air and heliox, incremental exercise test, constant workload (80% Wmax) exercise test and weekly 6-minute walk test. The two groups went through fifteen 30-minute retraining sessions in the overall framework of an identical pulmonary rehabilitation program. There was no significant difference in endurance improvement (Heliox: +52.5 sec, Air:+114sec, median value). FEV1 improvement under heliox exceeding 10% identified a group of 20 patients as "helium responders", who improved their endurance time by a median of 135sec compared to 50sec for the "non-responders" (non-significant difference). In patients with severe COPD, use of Heliox in exercise retraining did not produce significantly improved endurance. On the other hand, "helium responders" showed more FEV1 improvement than non-responders. Improved FEV1 under heliox should therefore be used in future studies as an inclusion criterion.

Heliox Prescribing Trends for Pediatric Critical Asthma.

Children with asthma exacerbations requiring pediatric ICU (PICU) admission, known as critical asthma (CA), are prescribed a variety of therapeutic interventions including heliox. Delivered invasively and noninvasively, heliox is employed to enhance deposition of aerosolized medications, improve obstructive pulmonary pathophysiology, and avoid complications associated with invasive mechanical ventilation. We used the Virtual Pediatric Systems database to update estimates of heliox prescription and explore for relationships between heliox and mechanical ventilation frequency and duration. We performed a retrospective cohort study using data from 97 PICUs among children 3-17 y of age admitted for CA from 2013-2019. The primary outcome was heliox prescribing rates and trends. Subgroup analyses assessed mechanical ventilation rates and duration by heliox exposure. Of 43,238 subjects studied, 1,070 (2.5%) were prescribed heliox. Mean heliox prescribing rates fell from 4.11% in 2013 to 2.37% in 2019. Heliox use was greater from centers in the South (2.6%) and Midwest (3.3%) as compared to the West (1.6%) and Northeast United States (1.6%, P < .001). In the subgroup assessing mechanical ventilation frequency, mechanical ventilation rates were 273/39,739 (0.7%) and greater for those provided heliox (1.9% vs 0.7%, P < .001). In the subgroup assessing mechanical ventilation duration, no differences in median mechanical ventilation duration were observed (4.94 [interquartile range [IQR] 3.04-6.36] vs 4.63 [IQR 3.11-7.30] d; P = .35) for those with and without heliox. In exploratory adjusted models, noninvasive heliox was not associated with mechanical ventilation. Mortality was rare (206/43,238 [0.47%]) and predominantly among subjects intubated prehospitalization (188/206 [91.3%]). Heliox as adjunctive therapy for children with CA is uncommon (2.5%) and not associated with mechanical ventilation or decreased mechanical ventilation duration in adjusted models. Updated estimates provided herein inform prospective controlled trial development to better define the role of heliox for CA.

Neonatal Applications of Heliox: A Practical Review.

Heliox is a mixture of helium and oxygen that may be utilized as an alternative to air-oxygen during the ventilatory support in the neonate. Special physical properties of Heliox, particularly low density, allow for improved gas flow and diffusion. First reports of Heliox use in the pediatric population were published in 1930s; however, this therapy has never gained widespread popularity despite its described beneficial effects. Historically, this was largely due to technical challenges associated with Heliox ventilation that significantly limited its use and realization of large-scale clinical trials. However, nowadays several commercially available ventilators allow easy and safe ventilation with both conventional and non-invasive modes. In the era of minimally invasive respiratory interventions in the newborn Heliox could be seen as a therapy that may potentially decrease the risk of non-invasive ventilation failure. This review presents pathophysiologic rationale for the use of Heliox in the newborn, and summarizes available data regarding applications of Heliox in the setting of neonatal intensive care unit based on clinical studies and findings from animal models. Mechanisms of action and practical aspects of Heliox delivery are thoroughly discussed. Finally, future research directions for neonatal use of Heliox are proposed.

The effect of albuterol with heliox versus albuterol nebulization in acute asthma exacerbation: a randomized controlled clinical trial.

Asthma is one of the most common chronic disorders of the respiratory tract. Thus, this study intended to evaluate the clinical effects and the peak flow metric effects of nebulized albuterol with heliox versus albuterol nebulization in acute asthma exacerbation. In this randomized clinical trial study, 109 patients with acute asthma attacks admitted to the emergency departments (EDs) in *** were enrolled. The patients were divided randomly into two groups: the intervention and control groups. The intervention group was nebulized with heliox (helium/oxygen-70: 30) plus albuterol with a 10 mL/min dose for 20 minutes three times, which lasted 60 minutes. The control group received standard treatment (albuterol in combination with oxygen). The results showed that the mean scores of FEV1 and PEFR after 20 minutes were significantly different in the two groups, as FEV1 scores in the intervention group were 2.76 and 3.01 at 20 and 60 minutes, respectively, while FEV1 scores in the control group were 1.99 and 2.64, respectively (P < 0.001). In addition, PEFR scores in the intervention group at 20 and 60 minutes were 299.24 and 310.57, respectively. However, these scores in the control group were 237.98 and 274.56, respectively (P < 0.001). The results showed that the use of heliox in t eating severe asthma attacks could be regarded as a different standard treatment that can lead to significantly better control of asthma attacks in the short term.

A hypothetic review on “HELIOX: The medium for conscious sedation in severely ill patients”

The uncooperativeness on behalf of the child has been conceptualized in different ways from time to time in the field of dentistry. The early signs of dental phobia are denoted by dental fear and dental anxiety which influence the daily living and resultin prolonged avoidance oftreatment. Thus, an obstacle to the success and quality of dental care. Various behavioral techniques are applied for management of a young, fearful, and uncooperative pediatric dental patients. However, there exist a portion of pediatric patients who are febrile andunable to tolerate the fearful circumstances and may require alternative approaches, such as conscious sedation or general anesthesia. General anesthesia being the most common modality for management of the uncooperative children but, the risk of morbidity and mortality associated are considerably higher compared to conscious sedation. The aim of this review is to provide a hypothetic view on use of HELIOX as an agent for conscious sedation.

Experience in the use of thermal heliox when carrying out rehabilitation measures for patients after suffering a coronavirus infection

Experience in the use of thermal heliox when carrying out rehabilitation measures for patients after suffering a coronavirus infection

IT’S ALL IN THE STORY: A MISLEADING CHEST CT

SESSION TITLE: Fellows Critical Care Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: An abnormal chest CT is a common reason for pulmonary consultation. There is a wide differential and a thorough history is important in helping to hone in on a diagnosis. Here, we present a case where the floridly abnormal chest CT was misleading. CASE PRESENTATION: The pulmonary team was consulted for an abnormal chest CT with request for bronchoscopy. A 32 yo woman without major past medical history presented to the ED short of breath - she described running for the bus and suddenly not being able to breathe. Labs on arrival significant for lactic and respiratory acidosis, suggesting near respiratory arrest. She improved rapidly with nebulizers, rest, and oxygen, and quickly weaned back to room air; her labs also improved rapidly. Her CXR showed patchy opacities so a chest CT was obtained showing diffuse ground glass opacities (Figure 1). She denied a wide range of exposures. Part of the thyroid obtained on the chest CT looked enlarged; she reported having been told several months ago that her thyroid was enlarged, and on exam it was noticeably large. A CT of the neck showed enlarged thyroid causing compression of the upper airway (Figure 2). We suspected the cause of her abnormal CT to be negative pressure pulmonary edema in the setting of likely upper airway obstruction caused by her enlarged thyroid. The initial ENT consult team did not feel this was related, however a secondary consult with endocrine surgery agreed with immediate resection of the thyroid. The patient was monitored in the MICU with heliox at the bedside, and underwent the resection without complication; she was surprisingly able to be intubated easily. She recovered fully and is now doing well; repeat CXR showed improvement. DISCUSSION: Negative pressure pulmonary edema (NPPE) is most commonly reported in the post-operative period from laryngospasm causing deep inspiration against a closed upper airway.1 This intense negative pressure pulls fluid into the alveolar space. Treatment involves addressing the underlying issue, whether it be laryngospasm or upper airway obstruction, with which the edema should rapidly resolve. Other cases have reported large thyroid masses causing similar presentations.2 Heliox can be used in cases of respiratory distress from narrowed airways, as its properties provide much less turbulent flow.3 It has been used to decrease intubation rates in children with croup, patients with subglottic stenosis, and even in severe asthma exacerbations. CONCLUSIONS: NPPE can cause an extremely abnormal chest CT, though the history and rapid improvement will help rule out other causes and rapidly narrow the differential. Heliox can be used to help improve oxygenation and ventilation in the setting of a narrowed upper airway. Patients improve with treatment of underlying obstruction or laryngopasm. Reference #1: Bhattacharya, M., Kallet, R. H., Ware, L. B. & Matthay, M. A. Negative-Pressure Pulmonary Edema. Chest 150, 927–933 (2016). Reference #2: Goh, K. J., Koh, M. S. & Tay, C. K. The Aftermath of Relieving an Upper Airway Obstruction. A Case of Postobstructive Pulmonary Edema. Am. J. Respir. Crit. Care Med. 198, e106–e108 (2018). Reference #3: Hashemian, S. M. & Fallahian, F. The use of heliox in critical care. Int. J. Crit. Illn. Inj. Sci. 4, 138–142 (2014). DISCLOSURES: No relevant relationships by Catherine Gao, source=Web Response No relevant relationships by Lisa Wolfe, source=Web Response

Heliox for inducible laryngeal obstruction (vocal cord dysfunction): A systematic literature review.

ObjectivesTo perform a systematic literature review on the use of Heliox with patients with inducible laryngeal obstruction/vocal cord dysfunction to: i) identify current evidence base; and ii) establish the methodological quality of published research.MethodsArticles published up to March 2018 were searched for key words and terms using Cochrane Library, MEDLINE, PubMed, CINAHL, EMBASE and Dynamed. Studies were included if they presented original research into the use of Heliox for vocal cord dysfunction.ResultsOnly three studies met the inclusion criteria for review. All reported favorable results for the use of Heliox as an adjunctive therapy for vocal cord dysfunction but none had sufficient methodological quality to support their conclusions.ConclusionDespite review articles recommending the use of Heliox in vocal cord dysfunction, there is a lack of good quality research to support this conclusion. There is a need for further research to investigate the effectiveness of Heliox as an adjunctive therapy for vocal cord dysfunction.Level of Evidence4

Does heliox administered by low-flow nasal cannula improve respiratory distress in infants with respiratory syncytial virus acute bronchiolitis? A randomised controlled trial

ObjectivesThe aim of our study is to evaluate whether the use of heliox (79:21) delivered through a low flow nasal cannula would improve respiratory distress in infants with acute bronchiolitis caused by RSV. MethodsWe have conducted a prospective randomised controlled study. All patients fulfilling inclusion criteria were randomised to either heliox (79:21) or air via NC at 2L/min for a continuous 24h. Measurements were taken at baseline, after 2h and at the end of the 24h. ResultsWe have included 104 patients into our study. The MCA-S did not show any significant difference between the two groups after 2h 4.3 vs. 4.1 (P=.78), or at 24h after 4.2 vs. 4.3 (P=.89). No difference was found in the proportion of participants progressed to MV, n-CPAP or oxygen via nasal cannula (RR 1.0, 0.86 and 0.89) (P=1.0, .77 and .73). There was no notable reduction in length of treatment in Heliox group 2.42 days vs. 2.79 days in air group P=.65. The oxygen saturation, PaO2, and PaCO2 did not have any statistical difference between the two studied groups after 2h and 24h of treatment. ConclusionOur data showed absence of any beneficial effect of heliox in a concentration (79:21) delivered through low flow nasal cannula in terms of respiratory distress improvement in infants with RSV acute bronchiolitis.

Heliox delivered by high flow nasal cannula improves oxygenation in infants with respiratory syncytial virus acute bronchiolitis

ObjectiveThe objective of this study is to evaluate the hypothesis that use of heliox would result in improvement of gas exchange when used with high flow nasal cannula in infants with RSV acute bronchiolitis. MethodsAll patients that met the inclusion criteria were randomized to either heliox (70:30) or air–oxygen mixture 30% via high flow nasal cannula at 8L/min for a continuous 24h. Measurements were taken at baseline, after 2h, and at the end of the 24h. ResultsThis prospective study included 48 patients. After 2h of treatment with heliox, the oxygen saturation and PaO2 significantly improved when compared with the air–oxygen group, 98.3% vs. 92.9%, 62.0mmHg vs. 43.6mmHg (p=0.04 and 0.01), respectively. Furthermore, PaO2/FiO2 ratio was significantly higher in the heliox group when compared with the air–oxygen group, 206.7 vs. 145.3. Nevertheless, CO2 showed better elimination when heliox was used, without significance. MWCA score dropped significantly in the heliox group, 2.2 points vs. 4.0 points in air–oxygen (p=0.04), 2h after starting the therapy. ConclusionTransient improvement of oxygenation in infants with RSV acute bronchiolitis during the initial phase of the therapy is associated with heliox when provided with HFNC, may provide a precious time for other therapeutic agents to work or for the disease to resolve naturally, avoiding other aggressive interventions.

Heliox delivered by high flow nasal cannula improves oxygenation in infants with respiratory syncytial virus acute bronchiolitis

ObjectiveThe objective of this study is to evaluate the hypothesis that use of heliox would result in improvement of gas exchange when used with high flow nasal cannula in infants with RSV acute bronchiolitis. MethodsAll patients that met the inclusion criteria were randomized to either heliox (70:30) or air–oxygen mixture 30% via high flow nasal cannula at 8L/min for a continuous 24h. Measurements were taken at baseline, after 2h, and at the end of the 24h. ResultsThis prospective study included 48 patients. After 2h of treatment with heliox, the oxygen saturation and PaO2 significantly improved when compared with the air–oxygen group, 98.3% vs. 92.9%, 62.0mmHg vs. 43.6mmHg (p=0.04 and 0.01), respectively. Furthermore, PaO2/FiO2 ratio was significantly higher in the heliox group when compared with the air–oxygen group, 206.7 vs. 145.3. Nevertheless, CO2 showed better elimination when heliox was used, without significance. MWCA score dropped significantly in the heliox group, 2.2 points vs. 4.0 points in air–oxygen (p=0.04), 2h after starting the therapy. ConclusionTransient improvement of oxygenation in infants with RSV acute bronchiolitis during the initial phase of the therapy is associated with heliox when provided with HFNC, may provide a precious time for other therapeutic agents to work or for the disease to resolve naturally, avoiding other aggressive interventions.

Clinical use of Heliox in Asthma and COPD

Heliox is a low density gas mixture of helium and oxygen commonly used in deep diving (> 6 ATM). This mixture has been also used for clinical purposes, particularly in the critical care setting. Due to of its physical proprieties, Heliox breathing reduces air flow resistances within the bronchial tree; in patients with obstructive lung diseases Heliox may also reduce the work of breathing and improve pulmonary gas exchange efficiency. Beneficial effects have been documented in severe asthma attacks and in patients with chronic obstructive pulmonary disease. A reduction in WOB during mechanical ventilation and an increase in exercise endurance capacity have also been described in COPD. Heliox has been also used in the treatment of upper airways obstruction, bronchiolitis and bronchopulmonary dysplasia. Despite the encouraging results, Heliox use in routine practice remains controversial because of technical implications and high costs.

Stridor in Neonates After Using the Microcuff® and Uncuffed Tracheal Tubes: A Retrospective Review.

We conducted a retrospective chart review to determine the frequency of stridor and contributing factors after the use of Microcuff® and uncuffed tracheal tubes (TTs) in neonates. All neonates in our neonatal intensive care unit whose airways were intubated between May 2011 and June 2012 were included. Data were collected from the neonatal intensive care unit database and from the electronic anesthesia record. Extracted data included postmenstrual age (PMA) at birth, birth weight, TT size and type, duration of tracheal intubation, and number of reintubations. The use of racemic epinephrine, heliox, and/or dexamethasone postextubation was considered diagnostic of stridor. Of the 324 neonates whose data were reviewed, 27 (8.3%) developed postextubation stridor. Neonates who developed stridor were more premature (PMA at birth, 29.9 ± 5.8 vs 33.0 ± 4.8 weeks, P = 0.001), had a lower birth weight (1.56 ± 1.07 vs 2.02 ± 0.96 kg, P = 0.005), greater duration of intubation (median: 20 vs 3 days, P < 0.0001), and multiple reintubations (median: 2 vs 0, P < 0.0001). The frequency of stridor was 17.2% after using Microcuff TT and 7.5% after using uncuffed TTs (Fisher exact test, 2-sided P = 0.08 [95% confidence interval for difference in proportions: -9.4% to 28.7%]). In a multivariable logistic regression model, after adjusting for PMA, birth weight, duration of intubation, and number of reintubations, the use of a Microcuff TT was associated with increased odds of stridor (adjusted odds ratio = 9.27 [95% confidence interval: 1.88-45.67], P = 0.006). The use of the Microcuff TT is associated with increased odds of postextubation stridor in neonates compared with the use of uncuffed TT.

Validation of volume delivery with the use of heliox in mechanical ventilation

Using a mixture of helium and oxygen (heliox) while mechanically ventilating patients to relieve lower airway obstruction is commonly practiced in intensive care units. The use of heliox with commercially available mechanical ventilators is usually accomplished by connecting the heliox mixture to the air inlet of the ventilator. Since most ventilators do not compensate for the difference in gas densities, particular attention to the delivered tidal volume (V T ) is required. We utilized a commercially available mechanical ventilator with an internal blending system that is capable of delivering heliox instead of medical air. It identifies and compensates for the gas mixture, theoretically enhancing stability in delivered and monitored parameters. Intubated, sedated male domestic pigs (n = 7) were ventilated with a mechanical ventilator equipped with an internal heliox blending system utilizing pressure assist control, pressure regulated volume control, and pressure support ventilation modes. Accuracy of volume delivery was assessed by comparing delivered V T measured at the patient wye using the variable orifice flow sensor connected to the ventilator and a heated 0-35 L/min pneumotachograph that was calibrated for flow, pressure, and volume, with a 0.80/0.20 heliox mix and 0.50 oxygen. A paired t-test was utilized with a P < 0.05. Pigs mean weight 9.0 ± 0.9 kg. Mean exhaled tidal volume for all modes and was 66 ± 16 mL. When comparing all modes for the 0.50 oxygen to the heliox mix, we found that exhaled tidal volume % difference increased when using heliox ( P ≤ 0.037). This study confirms that clinicians should be vigilant in monitoring delivered V T using a commercially available ventilator equipped with an internal heliox blending system. Accuracy of delivered V T can vary greatly with the use of heliox in this system, as well as other configurations.

Management of Status Asthmaticus

Status asthmaticus (SA) is a severe and life-threatening asthma exacerbation that requires aggressive treatment. First-line treatment entails continuous treatment of nebulized short-acting β-receptor agonists and intravenous (IV) steroid administration. This review article focuses on the current literature supporting the use of these medications as well as other treatment modalities such as inhaled anticholinergics, parenteral β-agonists, IV magnesium, and IV ketamine. We also explore the utility methylxanthines, volatile anesthetics, nitric oxide, antibiotics, IV fluids, and mucolytics in treating SA. Finally, we explore the data pertaining to the use of Heliox, non-invasive positive pressure ventilation, and bronchoscopy, and discuss ventilator management for patients with SA requiring intubation.

PRS7 - The Use of Heliox in Hospitalized Children From Cartagena Colombia

PRS7 - The Use of Heliox in Hospitalized Children From Cartagena Colombia

Heliox as a driving gas to atomize inhaled drugs on acute exacerbation of chronic obstructive pulmonary disease: a prospective clinical study

Background Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common condition, which affects not only the quality of life of patients but also their prognosis. The purpose of this study was to explore the effects of an inhaled salbutamol sulfate solution and an inhalation suspension of the glucocorticoid budesonide that were atomized with heliox to treat patients with AECOPD. Methods Twenty-three patients with AECOPD were divided into a treatment group (He/O2=70%/30%) and a control group (N2/O2=70%/30%). The salbutamol sulfate and budesonide were administered by inhalation twice a day for 7 days. Vital signs, arterial blood gas levels, pulmonary function and the levels of serum myostatin (sMSTN) were measured and lung vibration imaging was performed. Results We found that the PaO2 and PaCO2 values were not significantly different between the two groups at the various time points (P &gt;0.05). There were also no significant differences in any of the parameters of pulmonary function between the two groups. However, after baseline correction, the increase rate of the forced expiratory volume in one second (FEV1), the forced vital capacity (FVC), and the maximum minute ventilation (MVV) appeared to be significantly increased at some time points compared with the baseline (before treatment) in both groups (P &lt;0.05). Although the values of quantitative lung distribution (QLD) for different regions and the levels of sMSTN were slightly different between the two groups, the repeated measures analysis of variance (ANOVA) revealed that there were no significant differences between the two groups or within any group (P &gt;0.05). Conclusion Although the use of heliox as a driving gas can improve symptoms and benefit patients with AECOPD, the heliox treatment group did not have significant differences in arterial blood gases, lung function, lung vibration response imaging or the levels of sMSTN compared with the control group. (Chinese Clinical Trial Register Center ChiCTRTRC-00000273)

The use of heliox in critical care.

This paper reviews the medical use of helium oxygen mixture in obstructive airway disease in patients with croup, narrow endotracheal tubes (ETTs), respiratory distress syndrome, asthma, bronchiolitis, as well as patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and acute lung injury. In addition, some other indications of heliox use and some innovative methods of ventilation applied in pediatrics and adults are presented through review of the literature of current decade. Yet, to recommend heliox use seems to require more research based on clinical practice and observation through vaster and more robust investigations.