(360) Outcomes of Heliox Use in Children with Respiratory Compromise

Introduction: Heliox, a mixture of helium and oxygen, has been shown to improve laminar airflow and decrease airway resistance in children and adults. The objectives of this study are to evaluate the short-term outcomes of heliox use in children with upper airway obstruction and to identify variables associated with a need for surgical intervention.

Methods: A retrospective cohort study of children who received heliox for respiratory distress between 2012-2022 in a tertiary-care children’s hospital.

Results: A hundred and thirty-eight heliox treatments were recorded in 119 patients, age 34.1±46.4 months old. Twelve (10.1%) patients received heliox preemptively after laryngotracheal reconstruction. Of the remaining 107 patients, 48 (44.9%) underwent tracheostomy placement, airway reconstruction, or palliative care. Demographics, mean gestational age and age at heliox treatment were similar between the groups. Patients who were recommended a surgical intervention with tracheostomy or airway reconstruction were more likely to have secondary airway lesions (p < 0.0001), be enteral feed dependent (p < 0.0001), and have other significant comorbidities (p < 0.0001). Cumulative use of heliox over 48 hours was associated with a 6.2-fold increased risk of needing a tracheostomy tube placement or airway reconstruction (95% CI 2.56-14.13, p< 0.0001). Multivariate regression analysis identified neuromuscular disease, intracranial neuropathology, and cumulative time of heliox to be associated with a need for tracheostomy or airway reconstruction.

Conclusions: Prolonged use of heliox therapy in children is associated with an increased risk of tracheostomy and airway reconstruction, particularly in children with significant comorbidities.