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      • Record: found
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      Successful Extubation Using Heliox BiPAP in Two Patients with Postextubation Stridor

      case-report

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          Abstract

          Postextubation stridor is associated with significant morbidity. It commonly results in extubation failure after established medical treatment fails, such as nebulized epinephrine and/or intravenous steroids. The role of heliox (i.e., combination of helium and oxygen) in managing patients with postextubation stridor has not been fully established. We report two cases of postextubation stridor successfully treated with heliox delivered with bilevel positive airway pressure (BiPAP) after failure of standard medical therapy.

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          Clinical review: Post-extubation laryngeal edema and extubation failure in critically ill adult patients

          Bastiaan HJ Wittekamp, Walther NKA van Mook, Dave Tjan … (2009)
          Laryngeal edema is a frequent complication of intubation. It often presents shortly after extubation as post-extubation stridor and results from damage to the mucosa of the larynx. Mucosal damage is caused by pressure and ischemia resulting in an inflammatory response. Laryngeal edema may compromise the airway necessitating reintubation. Several studies show that a positive cuff leak test combined with the presence of risk factors can identify patients with increased risk for laryngeal edema. Meta-analyses show that pre-emptive administration of a multiple-dose regimen of glucocorticosteroids can reduce the incidence of laryngeal edema and subsequent reintubation. If post-extubation edema occurs this may necessitate medical intervention. Parenteral administration of corticosteroids, epinephrine nebulization and inhalation of a helium/oxygen mixture are potentially effective, although this has not been confirmed by randomized controlled trials. The use of non-invasive positive pressure ventilation is not indicated since this will delay reintubation. Reintubation should be considered early after onset of laryngeal edema to adequately secure an airway. Reintubation leads to increased cost, morbidity and mortality.
          Article 0 comments Cited 36 times – based on 0 reviews     Review now
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            Heliox for asthma in the emergency department: a review of the literature.

            J Harris, A G Reuben (2004)
            January 2002 saw the relaunch by BOC of Heliox, a gaseous mixture of helium and oxygen, for the use in a wide range of respiratory conditions. Despite a lapse of over 65 years since it was first used, and a large number of studies and case reports advocating its use, it remains an enigma, its use sporadic, and its role undefined. This paper reviews the discovery of helium and early medical use of helium oxygen mixtures and outlines areas where Heliox already has confirmed benefit as well as one or two areas that are currently under investigation. It will also look specifically at the use of Heliox in acute exacerbations of asthma and perform a thorough review of the current literature.
            Article 0 comments Cited 8 times – based on 0 reviews     Review now
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              Helium oxygen mixtures in the intensive care unit

              Jean-Claude Chevrolet (2001)
              Heliox, a mixture of helium and oxygen, has a density that is less than that of air. Breathing heliox leads to a reduction in resistance to flow within the airways, and consequently to a decrease in the work of breathing (WOB), particularly in disorders that are characterized by increased airways resistance. Beneficial effects have been observed in patients with asthma, chronic obstructive pulmonary disease (COPD), bronchiolitis, bronchopulmonary dysplasia and upper airways obstruction. Until we have conclusive data that attest to the efficacy of heliox in such conditions, its use will remain controversial. Meanwhile, it appears wise not to incorporate heliox therapy into routine practice because of technical complications and high costs.
              Article 0 comments Cited 7 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Case Rep Pulmonol
                Journal ID (iso-abbrev): Case Rep Pulmonol
                Journal ID (publisher-id): CRIPU
                Title: Case Reports in Pulmonology
                Publisher: Hindawi
                ISSN (Print): 2090-6846
                ISSN (Electronic): 2090-6854
                Publication date (Print): 2017
                Publication date (Electronic): 8 March 2017
                Volume: 2017
                Electronic Location Identifier: 1253280
                Affiliations
                1Department of Neurology, University of Missouri, 5 Hospital Drive, CE 540, Columbia, MO 65211, USA
                2Cleveland Clinic, Cerebrovascular Center, Neurological Institute, 9500 Euclid Avenue, Cleveland, OH 44195-5245, USA
                Author notes
                *Christopher R. Newey: neweyc@ 123456health.missouri.edu

                Academic Editor: Fabio Midulla

                Author information
                http://orcid.org/0000-0002-9386-7791
                Article
                DOI: 10.1155/2017/1253280
                PMC ID: 5360960
                PubMed ID: 28373921
                SO-VID: 82108dc1-81ad-4f8c-ac4c-a5b70f1ca374
                Copyright © Copyright © 2017 Pragya Punj et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 21 December 2016
                Date accepted : 2 March 2017
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Respiratory medicine
                Data availability:
                ScienceOpen disciplines: Respiratory medicine

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