Question

• In children with moderate asthma exacerbation, can the use of heliox to deliver albuterol NMTs, compared with oxygen to deliver albuterol NMTs, prevent of hospital admissions?

Clinical Bottom Lines

1. Both studies showed interesting trends but no differences in hospital admission.
2. For admission: NNT = 5 in Rivera et al, and NNT = 3 in Kim et al, but these are small studies
3. Rivera et al showed no difference in pulmonary parameters, but Kim et al did.
4. The difference in the two studies may relate to length of albuterol treatment.
5. Heliox to deliver albuterol NMTs may not ready for primetime

Summary of Key Evidence

1. Dyspnea index scores for heliox group: 6 -> 2
2. Dyspnea index scores for oxygen group: 5 -> 3 (p = 0.062)
3. 12/20 (60%) in heliox group were admitted; 17/21 (81%) in oxygen group were admitted
   For admissions: ARR = 21%, NNT = 5, RRR 26% Kim et al.¹
4. Mean change in PI for the heliox group was 6.67, compared with 3.33 for the oxygen group (p < 0.001). A clinically significant change was noted at 125 minutes, and sustained at 150, 180, and 240 minutes.
5. 10/15 children were discharged from the ED in the heliox group compared to 5/15 in the oxygen group (p = 0.07).
6. For admissions: RRR = 50%; ARR = 33%, NNT = 3.²

Additional Comments

• Another interesting aspect would be whether heliox would allow quicker ED discharges. This may be good from the perspectives of both ED patient flow and from the parent perspective. This should be balanced against the cost of heliox ($70/tank according to RT).

Citation

1. Kim IK, Phrampus E, Venkataraman S, et al. Helium/oxygen-driven albuterol nebulization in the treatment of children with moderate to severe asthma exacerbations: a randomized, controlled trial. Pediatrics 2005; 116:1127-33.

2. Rivera ML, Kim TY, Stewart GM, Minasyan L, Brown L. Albuterol nebulized in heliox in the initial ED treatment of pediatric asthma: a blinded, randomized, controlled trial. Am J Emerg Med 2006;26:38-42.

CAT Author: Sushant Srinivasan, MD

CAT Appraisers: Stephen Park, MD

Date appraised: June 7, 2006