Helium-oxygen Mixture Research Articles

Experiments on the instability modes of buoyant diffusion flames and effects of ambient atmosphere on the instabilities

Large scale dynamic behavior of buoyant diffusion flames were studied experimentally. It was found that buoyant diffusion flames originating from circular nozzles exhibit two different modes of flame instabilities. The first mode results in a sinuous meandering of the diffusion flame, characteristic of flames originating from small diameter nozzles. This instability originates at some distance downstream of the nozzle exit in the contraction region of the buoyant flame envelope and develops into a sinuous motion of the flame. The second mode is the varicose mode which develops very close to the nozzle exit as axisymmetric perturbations of a contracting flame surface. In this mode, flame oscillations result in the formation of toroidal vortical structures that convect through the flame and cause periodic burn out at the flame top resulting in the observed flame height fluctuations. The average flame heights are found to be typically shorter for these flames. The oscillation frequencies and their scaling for the two modes are also different with the sinuous mode having higher frequencies than the varicose mode. It was also observed that the instability can switch from one mode to the other and the probability of observing the varicose mode appears to increase with increasing Richardson number. Additionally, the feasibility of altering the behavior of buoyant diffusion flames was explored through variation of the oxidizer medium density. It was found that the flame oscillations can be completely suppressed for flames burning in helium rich helium–oxygen mixtures. At lower helium concentrations, the oscillation frequency can be significantly reduced. In order to enhance the buoyancy effect, CO2–O2 mixtures were also studied. However, the density increase and its effects on flame oscillation frequency were found to be small compared to those flames burning in air. These experiments point towards the feasibility of altering buoyant flame behavior under earth gravity and studying the large scale dynamical aspects of buoyant flames without the need of variable gravity environment.

TREATMENT OF ACUTE ASTHMA: A New Look at the Old and at the New

beta-Agonists remain the mainstay of therapy for acute asthma and, for most patients, standard doses are acceptable. Although the onset of action of systemic steroids is still not clear, steroids promote recovery and should be given to patients with acute illness. Intravenous magnesium sulfate appears to improve pulmonary function in the most severely ill patients but is not useful in patients with more moderate episodes. Ipratropium bromide is a weak bronchodilator that still needs to be tested as an adjunct to standard treatment regimens before its role in adults with asthma can be determined; given its ease of use and favorable safety profile it could be considered for patients with more severe acute illness. Aminophylline has not been found by most studies to improve outcomes and the narrow therapeutic range and unfavorable safety profile relegate it to a last-line agent or no use at all. Helium-oxygen mixtures currently have no role in moderately ill patients but have a theoretical advantage as a temporizing measure in severely ill patients. Drugs used in the management of chronic asthma, such as inhaled steroids and leukotriene-modifying agents, are making their way into the acute treatment arena, and other newly developed specific mediator inhibitors or blockers deserve attention. The use of isomers of beta-agonists is another area that is attracting attention and study. Systemic steroids are used to prevent relapse after emergency department discharge and the addition of other agents such as leukotriene-modifying agents or inhaled steroids may further prevent the need for urgent visits or hospitalization. The search for optimal treatment strategies for acutely ill patients is challenging and exciting and, with more attention and resources being devoted to this area, newer treatments will be found that will eventually have a greater impact on the high morbidity associated with acute asthma.

Helium-Oxigen (Heliox) mixture in airway obstruction

OBJECTIVE: Demonstrate the effectiveness and the good outcome of the patients treated with helium-oxygen (Heliox) mixture. This mixture (Heliox) has been used in patients with airway obstruction, from different ethiologies, who did not respond to a conventional treatment with oxygen. METHODS: Case report of five patients that received Heliox as treatment for airway obstruction. All of them had good results without side effects during the treatment. CONCLUSION: Heliox is a promising treatment for severe airway obstruction with good results in a short period of time, until the final treatment is established.

The use of helium-oxygen mixture in the ventilation study of children with chronic obstructive lung disease

OBJECTIVE: To study the distribution of Tc-99m DTPA radioaerosol when heliox or oxygen are used in the nebulization of children and adolescents with chronic obstructive pulmonary disease during pulmonary ventilation scintigraphy. MATERIAL AND METHODS: Clinical randomized and controlled trial. Patients with chronic obstructive pulmonary disease (5 to 18 years old) who required pulmonary scintigraphy between March 1996 and September 1998 were included. Obstruction of the lower airway was measured by spirometry. Patients were randomized into two groups according to the gas used for nebulization during scintigraphy: heliox (80% helium and 20% oxygen) or oxygen. Scintigraphy studies were expressed as slope of the cumulative pulmonary radioactivity uptake curve and as the maximal cumulative radioactivity in the lung. The mean diameter of the Tc-99m DTPA particles generated by heliox and oxygen was measured by laser diffraction. RESULTS: Ten patients were allocated in each group. There were no statistical differences (P>0.05) in terms of gender, main diagnosis, signs of malnutrition, mean values of weight, height, body area, or spirometry results. The mean slope in the heliox group (5,039-/+1,652) was significantly different (P=0.018) from the mean slope of the oxygen group (3,410-/+1,100). The mean slope of patients with severe airflow obstruction in the heliox group was statically different (P=0.017) from the mean slope of patients with airflow obstruction in the oxygen group. In both groups, patients without evidence of airflow obstruction were similar in terms of mean slopes (P=0.507) and mean cumulative radiation in the lung (P=0.507). The mean diameter of heliox-generated Tc-99m DTPA particles was 2.13 m (-/+0.62). This was statistically different (P=0.004) from the mean diameter of oxygen-generated particles (0.88-/+0.99 m). CONCLUSIONS: Nebulization with heliox was more efficacious than nebulization with oxygen for distribution and dispersion of Tc-99m DTPA radioaerosol in the lungs of children and adolescents with chronic obstructive pulmonary disease submitted to ventilation scintigraphy. The benefits of heliox over oxygen are more evident in the presence of lower airway obstruction. Without airway obstruction, we did not observe any difference in the distribution and dispersion of radioaerosol in the lungs. Although the mean diameter of the Tc-99m DTPA particles generated by heliox and oxygen was significantly different, the particles generated by both gases were still within the recommended range (between 1 and 5 m). Therefore, this difference does not account for the effects of heliox observed in this study.

Helium-oxygen mixture does not improve gas exchange in mechanically ventilated children with bronchiolitis.

STATEMENT OF FINDINGS: Varying concentrations of helium-oxygen (heliox) mixtures were evaluated in mechanically ventilated children with bronchiolitis. We hypothesized that, with an increase in the helium:oxygen ratio, and therefore a decrease in gas density, ventilation and oxygenation would improve in children with bronchiolitis. Ten patients, aged 1-9 months, were mechanically ventilated in synchronized intermittent mandatory ventilation (SIMV) mode with the following gas mixtures delivered at 15-min intervals: 50%/50% nitrogen/oxygen, 50%/50% heliox, 60%/40% heliox, 70%/30% heliox, and return to 50%/50% nitrogen/oxygen. The use of different heliox mixtures compared with 50%/50% nitrogen/oxygen in mechanically ventilated children with bronchiolitis did not result in a significant or noticeable decrease in ventilation or oxygenation.

Oxygenation in status asthmaticus improves during ventilation with helium-oxygen.

To determine the effect of breathing helium-oxygen (HELIOX) mixtures on pulmonary gas exchange during severe asthma. A retrospective case-match control design was used to compare the changes in alveolar to arterial gradient [(A-a)gradient] in the first 2 hrs of mechanical ventilation (MV) for status asthmaticus (SA) in patients who received HELIOX with those who did not. Patients were matched for diagnosis of asthma, ventilatory failure, ventilator mode and settings, and equivalent pharmacologic therapy. The adult and pediatric intensive care units of a tertiary-care hospital. Adult and pediatric patients undergoing MV for SA. Use of HELIOX or standard nitrogen-oxygen mixtures during MV. A total of 11 patients receiving HELIOX in the first 2 hrs of MV for SA were compared with 11 case-matched controls who did not. At baseline, the HELIOX and control groups had similar (A-a)gradients (216+/-92 torr and 226+/-82 torr, respectively). The (A-a)gradient decreased significantly to 85+/-44 torr after initiation of ventilation with HELIOX (p < .0003), whereas it did not change significantly in the control group in a similar time frame and during identical treatment without HELIOX. The reduction in (A-a)gradient in the HELIOX group facilitated a reduction in F(IO)2 from 0.8+/-0.2 initially to 0.4+/-0.1 at the time of the second blood gas determination, thus permitting greater concentrations of helium to be administered. MV with HELIOX improves (A-a)gradient in patients with SA. Although this improvement adds little to routine therapy with supplemental oxygen, it does permit reduction in concentration of inspired oxygen to levels that maximize helium concentration and thus permit full benefits of HELIOX on lung mechanics to be realized in even the most severely ill asthmatics.

Effects of gas density on experimentally obstructed ventilation during acute hypoxia

When patients with obstructive lung disease breathe helium–oxygen mixtures, their arterial P CO 2 is lowered towards normal, indicating more effective ventilation. However, there is a lack of detailed respiratory data from clinical cases, so that the mechanisms remain unclear. To study relevant variables during hypoxemia and obstruction in the absence of disease, we undertook experiments with healthy subjects breathing normoxic and hypoxic gas mixtures of differing densities (air, 13.7% O 2 in N 2 and 13.7% O 2 in helium) through an experimental obstruction (resistive airway loading). This increased airway resistance was twice that reported from the ambient-pleural pressure differences in patients with moderately severe emphysema. Without imposed resistance the total ventilation ( V ̇ e ) increased 27% on both hypoxic mixtures. With normoxia, the obstruction increased tidal volume but decreased frequency so that V ̇ e and alveolar ventilation ( V ̇ a ) were essentially unchanged. With hypoxia, breathing pattern changed similarly, but now V ̇ e decreased while V ̇ a was maintained. Helium returned the breathing patterns toward normal. Obstruction lowered the rapid increase in V ̇ e from two or three breaths of N 2, but the decrease from two or three breaths of O 2 was unchanged. We detected an increase in metabolic rate with obstructed breathing that was reduced by the helium mixtures. The remarkable finding was that despite the obstruction being markedly uncomfortable because of the high resistance, we did not find any substantial disturbance in gas exchange, compared to hypoxia with no obstruction. Thus, the main mechanisms responsible for improved blood gases in patients breathing helium mixtures were outside the scope of our experiment and likely related to disease factors.

Thermoregulation and repeatability of oxygen-consumption measurements in winter- acclimatized North American porcupines (Erethizon dorsatum)

We measured the thermoregulatory responses of 13 North American porcupines (Erethizon dorsatum) to low ambient temperatures during respirometry trials in both air and a helium-oxygen gas mixture (helox). The objective was to quantify the energy metabolism of porcupines under varying ambient temperatures. The basal metabolic rate of our winter-acclimatized porcupines was higher than expected for animals of their body size, whereas thermal conductance was lower than allometric predictions. The increase in metabolic rate that we observed at -20°C was ca. 2 X BMR, although this was not the animals' maximum thermogenic capacity. The mean increase in thermal conductance for individuals placed in a helox atmosphere over that measured in an oxygen atmosphere was 1.91 and this represented a metabolic rate of ca. 3 X BMR at -20°C. We also determined that the repeatability of oxygen-consumption measurements below thermoneutrality were highly repeatable over medium-length time intervals (mean = 11 days) for both absolute and residual values.

Use of Heliox-Driven Nebulizer Therapy in the Treatment of Acute Asthma

Study objective: To compare the effectiveness of a helium-oxygen mixture with that of oxygen alone as an aerosolizing gas for β-agonist therapy in patients with mild to moderate exacerbation of asthma. Methods: A prospective, single-blinded study was performed in an urban teaching hospital over a period of 5 months. A convenience sample of 205 patients with mild to moderate exacerbation of asthma were enrolled. The participants were randomly assigned to 1 of 2 groups. The first group received 3 doses of albuterol, 5.0 mg aerosolized in 10 L/min of oxygen, 15 minutes apart. The second group received 3 doses of albuterol, 5.0 mg aerosolized in 10 L/min of a 70:30 helium-oxygen mixture (heliox), 15 minutes apart. Peak expiratory flow rate (PEFR), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV 1 ) were measured before and after each treatment. Only PEFR and FEV 1 were used in data analysis. Results: Although both the heliox and the oxygen group showed significant improvement in PEFR from baseline after 45 minutes (72% and 70%, respectively), the difference between the 2 groups was clinically and statistically insignificant ( P =.56). Similar findings were observed for FEV 1 . There was no difference in rate of admission or rate of complications between the 2 groups. Conclusion: Despite its ability to decrease the turbulent flow in airways and to reach distal pulmonary tissues, heliox had no clinically significant advantage over standard therapy in the treatment of mild to moderate asthma. Further large-scale studies are necessary to determine the clinical efficacy of heliox in this setting. [Henderson SO, Acharya P, Kilaghbian T, Perez J, Korn CS, Chan LS: Use of heliox-driven nebulizer therapy in the treatment of acute asthma. Ann Emerg Med February 1999;33:141-146.]

In vivo and in vitro hyperbaric studies in mice suggest novel sites of action for ethanol.

The present study uses increased atmospheric pressure as an ethanol antagonist to test the hypothesis that allosteric coupling pathways in the GABA(A) receptor complex represent initial sites of action for ethanol. This was accomplished using behavioral and in vitro measures to determine the effects of pressure on ethanol and other GABAergic drugs in C57BL/6 and LS mice. Behaviorally, exposure to 12 times normal atmospheric pressure (ATA) of a helium-oxygen gas mixture (heliox) antagonized loss of righting reflex (LORR) induced by the allosteric modulators ethanol and pentobarbital, but did not antagonize LORR induced by the direct GABA agonist 4,5,6,7-tetrahydroisoxazolo-pyridin-3-ol (THIP). Similarly, exposure to 12 ATA heliox antagonized the anticonvulsant effects verses isoniazid of ethanol, diazepam and pentobarbital. Biochemically, exposure to 12 ATA heliox antagonized potentiation of GABA-activated 36Cl-uptake by ethanol, flunitrazepam and pentobarbital in LS mouse brain preparations, but did not alter GABA-activated 36Cl- uptake per se. In contrast to its antagonist effect versus other allosteric modulators, pressure did not antagonize these behavioral or in vitro effects induced by the neuroactive steroid, 3alpha-hydroxy-5beta-pregnan-20-one (3alpha,5beta-P). These findings add to evidence that pressure directly and selectively antagonizes drug effects mediated through allosteric coupling pathways. The results fit predictions, and thus support the hypothesis that allosteric coupling pathways in GABA(A) receptors represent initial sites of action for ethanol. Collectively, the results suggest that there may be common physicochemical and underlying structural characteristics that define ethanol sensitive regions of receptor proteins and/or their associated membranes that can be identified by pressure within (e.g., GABA(A)) and possibly across (e.g., GABA(A), NMDA, 5HT3) receptors.

Heliox improves pulmonary mechanics in a pediatric porcine model of induced severe bronchospasm and independent lung mechanical ventilation.

BACKGROUND: A helium-oxygen gas mixture (heliox) has low gas density and low turbulence and resistance through narrowed airways. The effects of heliox on pulmonary mechanics following severe methacholine-induced bronchospasm were investigated and compared to those of a nitrogen-oxygen gas mixture (nitrox) in an innovative pediatric porcine, independent lung, mechanical ventilation model. RESULTS: All of the lungs showed evidence of severe bronchospasm after methacholine challenge. Prospective definition of 'heliox response' was a 15% or greater improvement in lung function in the lung receiving heliox compared with the matched lung receiving nitrox. Seven out of 10 pigs responded to heliox therapy with respect to resistance and eight out of 10 pigs responded to heliox therapy with respect to compliance and tidal volume (P < 0.03). After crossover from nitrox to heliox, eight out of eight lungs significantly improved with respect to tidal volume, resistance and compliance (P < 0.001). After crossover from heliox to nitrox all eight lungs showed a significant increase in resistance and a significant decrease in tidal volume (P < 0.001). CONCLUSIONS: In a pediatric porcine model of acute, severe methacholine-induced bronchospasm and independent lung mechanical ventilation, administration of heliox improves pulmonary mechanics, gas flow, and ventilation. Administration of heliox should be considered for support of pediatric patients with acute, severe bronchospasm requiring mechanical ventilation through small artificial airways.

Regional Deposition of Inhaled Evans Blue Dye in Mechanically Ventilated Rabbits with Air or Helium Oxygen Mixture

An animal model has been used and further developed to examine and evaluate differences in regional deposition patterns of an Evans Blue dye (EB) tracer aerosol. This was done by using different carrier gas composition of either He-O2 (80% helium, 20% oxygen) or air (79% nitrogen, 21% oxygen) in histamine-provoked and nonprovoked rabbits. The ratio of peripheral deposition to total deposition (central + peripheral), in relation to percentage increase in intratracheal pressure (ITPΔ%), was used as an evaluation tool. The animals were tracheostomized, cannulated, and ventilated in a volume-controlled mode until they were stable. Saline or histamine was then administrated for 2 min before the tracer aerosol EB was given. The percentage increase in intratracheal pressure before and after provocation was calculated (7TPA%) and was, on average, 51 ± 20% for air and 51 ± 20% for He-O2. EB was extracted from lung tissues and measured with a spectrophotometer. The absorbance in different lung regions was used as a measure of the distribution of aerosol. Bronchial provocation gave a central deposition 0.55 ± 0.11 (mean ± SD, ratio = peripheral deposition/central + peripheral deposition) compared to 0.80 ± 0.09 in the control group. He-O2-ventilated rabbits showed significantly higher peripheral deposition ratio (0.67 ± 0.12) compared with air-ventilated rabbits (0.55 ± 0.11). The latter finding may be due to the difference in the degree of turbulent flow. There were significant correlations between intratracheal peak pressure and peripheral deposition, r = -.60 and r = -.71 for air and He-O2, respectively. This study demonstrates the possibility of using a rabbit model and different carrier gases for evaluation of effects of bronchial provocation.

Malignant Airway Obstruction: Recognition and Management

Malignant airway obstruction affects up to 80,000 patients annually, many of whom will present acutely to the emergency department (ED). This clinical entity should be sought in any patient presenting to the ED with increasing shortness of breath, recurrent chest infections, hemoptysis, and an inability to lie flat. Interventions suggested in malignant airway obstruction include: maintenance of spontaneous ventilation by avoiding respiratory depressing sedation, muscle relaxants or narcotics; changes in patient’s position; avoidance of general anesthesia and positive pressure ventilation, if possible; placement of endotracheal tube beyond the level of obstruction; radiotherapy; corticosteroids; availability of helium-oxygen mixtures, cardiopulmonary bypass, or extracorporeal membrane oxygenation. If time allows, further diagnostic studies will be of assistance in assessing the best therapy before definitive intervention.

Early morphological findings in experimental high pressure neurological syndrome

HPNS (high pressure neurological syndrome) is considered to be reversible condition of the nervous system caused by elevated (atmospheric) pressure. Clinical observations and experimental findings gave rise to the belief that this syndrome at least partly functions as a model of a dopamin dependent psychosis. Morphological alterations during or after HPNS in man and animals have not been reported so far. We treated rats for three hours with an increasing pressure of helium-oxygen mixture up to 61 ATA in a pressure chamber. This pressure was subsequently maintained for one hour and then released to zero within twenty seconds. The rats died within the first three seconds of pressure release due to complete deoxygenation. Brains were immediately removed and either cooled in liquid nitrogen or fixed in formalin. In both instances the central nervous tissue was excellently preserved. In paraffin embedded formalin fixed specimens, dark neurons in different brain regions were found, especially within parts of the dentate gyrus, the CA 4 subfield of the ammons horn, in dopaminergic brainstem nuclei and in some cortical pyramidal cells. In dopaminergic cells, tyrosine hydroxylase was found to be absent in cells transformed into dark neurons. These dark neurons which have long been recognized in neuropathology, probably represent reversibly damaged neurons transformed into the dark configuration by aldehyde fixation. They may correspond to early apoptosis or they may be the consequence of cytoskeletal disruption.

Surface properties and the stability of poly(ethylene terephtalate) films treated in plasmas of helium‐oxygen mixtures

In this work, the surface treatment of poly(ethylene terephtalate) (PET) films in a low frequency (70 kHz) discharge in helium-oxygen mixtures is investigated. Optical emission spectroscopy and mass spectrometry are used to analyze the gas phase. Surface properties are analyzed via the X-ray photoelectron spectroscopy (XPS) technique and contact angle measurements. The treatment conditions are optimized in order to obtain a surface functionalization, which would show a reduced ageing effect. The stability of the treated surface via the crosslinking process seems to be closely correlated to the presence of the helium metastable species in the discharge. A very good stability with the ageing time is obtained for samples treated in gaseous mixtures that contain less than 5% O2, conditions for which the oxidized polymeric structure seems to be formed on a reinforced crosslinked layer. The very efficient loss of He excited species, for amounts of O2 higher than a few percent, affects the surface crosslinking. For high quantities of oxygen introduced in the reactor (more than about 50%), a balance is established between the introduction of oxygenated groups and the ablation of the surface. In this case, the surface degradation has, as a consequence, the ageing effect. © 1997 John Wiley & Sons, Inc. J Appl Polym Sci 66: 1367–1375, 1997

Surface properties and the stability of poly(ethylene terephtalate) films treated in plasmas of helium‐oxygen mixtures

In this work, the surface treatment of poly(ethylene terephtalate) (PET) films in a low frequency (70 kHz) discharge in helium-oxygen mixtures is investigated. Optical emission spectroscopy and mass spectrometry are used to analyze the gas phase. Surface properties are analyzed via the X-ray photoelectron spectroscopy (XPS) technique and contact angle measurements. The treatment conditions are optimized in order to obtain a surface functionalization, which would show a reduced ageing effect. The stability of the treated surface via the crosslinking process seems to be closely correlated to the presence of the helium metastable species in the discharge. A very good stability with the ageing time is obtained for samples treated in gaseous mixtures that contain less than 5% O2, conditions for which the oxidized polymeric structure seems to be formed on a reinforced crosslinked layer. The very efficient loss of He excited species, for amounts of O2 higher than a few percent, affects the surface crosslinking. For high quantities of oxygen introduced in the reactor (more than about 50%), a balance is established between the introduction of oxygenated groups and the ablation of the surface. In this case, the surface degradation has, as a consequence, the ageing effect. © 1997 John Wiley & Sons, Inc. J Appl Polym Sci 66: 1367–1375, 1997

Surface properties and the stability of poly(ethylene terephtalate) films treated in plasmas of helium-oxygen mixtures

Surface properties and the stability of poly(ethylene terephtalate) films treated in plasmas of helium-oxygen mixtures

EEG and sleep disturbances during dives at 450 msw in helium-nitrogen-oxygen mixture.

To study the effects of nitrogen addition to the breathing mixture on sleep disturbances at pressure, two dives were performed in which helium-nitrogen-oxygen mixture was used up to 450 m sea water (msw). In total, sleep of 12 professional divers was analyzed (i.e., 184 night records). Sleep was disrupted by compression and by stay at 450 msw: we observed an increase in awake periods and in sleep stages I and II and a decrease in stages III and IV and in rapid-eye-movement sleep periods. These changes, which were more intense at the beginning of the stay, began to decrease from the seventh day of the stay, but the return to control values was recorded only during the decompression at depths below 200 msw. These changes were equivalent to those recorded in other experiments with helium-oxygen mixture in the same range of depths and were independent of the intensity of changes recorded in electroencephalographic activities in awake subjects.

ANXIETY, SENSORIMOTOR AND COGNITIVE PERFORMANCE DURING A HYDROGEN–OXYGEN DIVE AND LONG-TERM CONFINEMENT IN A PRESSURE CHAMBER

Occupational deep diving is an extreme situation that is characterized by both social and physical stressor agents such as long-term confinement and high-pressure exposure. High pressure is known to be a basic aetiological factor underlying central nervous system changes that include psychosensorimotor disorders. The authors report anxiety, sensorimotor, and cognitive responses in commercial divers participating in a hydrogen–oxygen experimental dive to 300 metres depth with long-term confinement in a pressure chamber. Anxiety data confirm that living and working in a high pressure of inert gases is not inherently stressful and further support the view that the main factor involved in the development of diving anxiety is the social environment rather than the physical environment. Alternatively, the cognitive and behavioural data suggest that the future of hydrogen as a diving gas could be limited, at least for depths greater than 200 metres, to an additional role to the basic helium–oxygen mixture.

Helium-oxygen therapy in the emergency department

Helium is an inert gas with unique physical properties that allow it to be used for various respiratory emergencies. Because of its low specific gravity and low viscosity, the passage of helium through the respiratory tract is smoother, more laminar, and less turbulent than either air or oxygen. These properties have prompted the use of helium and oxygen in patients with airway obstructions due to tumor, foreign body, edema, or bronchoconstriction. Helium-oxygen has been used to facilitate bronchoscopy through small diameter endotracheal tubes and to increase the effectiveness of high-frequency jet ventilation. Helium has been successful in the treatment of spinal cord decompression sickness seen in divers. Helium-oxygen mixtures are commercially available and may be useful in the emergency department to treat patients with airway obstruction. This article reviews literature concerning the use of helium-oxygen gas mixtures in the emergency department. Additional research conducted in the future may further define the use of this unique gas mixture in the emergency department.