Helium-oxygen reduces work of breathing in mechanically ventilated patients with chronic obstructive pulmonary disease

Abstract

Objective: To evaluate whether helium-oxygen mixture reduces inspiratory work of breathing (WOB) in sedated, paralyzed, and mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Design and setting: Open, prospective, randomized, crossover study in the medical intensive care unit in a university hospital. Patients and participants: 23 patients admitted for acute exacerbation of COPD and mechanically ventilated. Measurements: Total WOB (WOBt), elastic WOB (WOBel), resistive WOB (WOBres), and WOB due to PEEPi (WOBPeepi) were measured. Static intrinsic positive end expiratory pressure (PEEPi), static compliance (Crs), inspiratory resistance (Rins), inspiratory (tinsp) and expiratory time constant (texp) were also measured. These variables were compared between air-oxygen and helium-oxygen mixtures. Results: WOBt significantly decreased with helium-oxygen (2.34±1.04 to 1.85±1.01 J/l, p<0.001). This reduction was significant for WOBel (1.02±0.61 J/l to 0.87±0.47, p<0.01), WOBPeepi (0.77±0.38 J/l to 0.54±0.38, p<0.001), and WOBres (0.55±0.19 J/l to 0.44±0.24, p<0.05). PEEPi, Rins, tinsp and texp significantly decreased. Crs was unchanged. Conclusions: Helium-oxygen mixture decreases WOB in mechanically ventilated COPD patients. Helium-oxygen mixture could be useful to reduce the burden of ventilation.