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Helium-oxygen versus air-oxygen noninvasive pressure support in decompensated chronic obstructive disease: A prospective, multicenter study.

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Názov: Helium-oxygen versus air-oxygen noninvasive pressure support in decompensated chronic obstructive disease: A prospective, multicenter study.
Autori: Jolliet, P., Tassaux, D., Roeseler, J., Burdet, L., Broccard, A., D'Hoore, W., Borst, F., Reynaert, M., Schaller, M.D., Chevrolet, J.C.
Rok vydania: 2025
Zbierka: Université de Lausanne (UNIL): Serval - Serveur académique lausannois
Predmety: APACHE, Aged, Blood Gas Analysis, Cost-Benefit Analysis, Dyspnea/etiology, Female, Helium/economics, Helium/therapeutic use, Hospital Costs/statistics & numerical data, Hospital Mortality, Humans, Intensive Care Units/statistics & numerical data, Intubation, Intratracheal/statistics & numerical data, Length of Stay/statistics & numerical data, Male, Middle Aged, Oxygen/economics, Oxygen/therapeutic use, Oxygen Inhalation Therapy/economics, Oxygen Inhalation Therapy/methods, Positive-Pressure Respiration/economics, Positive-Pressure Respiration/methods, Prospective Studies, Pulmonary Disease, Chronic Obstructive/complications, Chronic Obstructive/mortality, Safety, Switzerland/epidemiology, Treatment Outcome
Popis: OBJECTIVE: To study whether noninvasive pressure support ventilation (NIPSV) with helium/oxygen (He/oxygen), which can reduce dyspnea, PaCO2, and work of breathing more than NIPSV with air/oxygen in decompensated chronic obstructive pulmonary disease, could have beneficial consequences on outcome and hospitalization costs. DESIGN: Prospective, randomized, multicenter study. SETTING: Intensive care units of three tertiary care university hospitals. PATIENTS: All patients with chronic obstructive pulmonary disease admitted to the intensive care units for NIPSV during a 24-month period. INTERVENTIONS: Patients were randomized to NIPSV with air/oxygen or He/oxygen. NIPSV settings, number of daily trials, decision to intubate, and intensive care unit and hospital discharge criteria followed standard practice guidelines. RESULTS: A total of 123 patients (male/female ratio, 71:52; age, 71 +/- 10 yrs, Acute Physiology and Chronic Health Evaluation II, 17 +/- 4) were included. Intubation rate (air/oxygen 20% vs. He/oxygen 13%) and length of stay in the intensive care unit (air/oxygen 6.2 +/- 5.6 vs. He/oxygen 5.1 +/- 4 days) were comparable. The post-intensive care unit hospital stay was lower with He/oxygen (air/oxygen 19 +/- 12 vs. He/oxygen 13 +/- 6 days, p < .002). Cost of NIPSV gases was higher with He/oxygen, but total hospitalization costs were lower by $3,348 per patient with He/oxygen. No complications were associated with the use of He/oxygen. CONCLUSION: He/oxygen did not significantly reduce intubation rate or intensive care unit stay, but hospital stay was shorter and total costs were lower. He/oxygen NIPSV can be safely administered and could prove to be a cost-effective strategy.
Druh dokumentu: article in journal/newspaper
Jazyk: English
ISSN: 0090-3493
Relation: Critical Care Medicine; https://iris.unil.ch/handle/iris/76945; serval:BIB_29817; 000181846800034
DOI: 10.1097/01.CCM.0000055369.37620.EE
Dostupnosť: https://iris.unil.ch/handle/iris/76945
https://doi.org/10.1097/01.CCM.0000055369.37620.EE
Prístupové číslo: edsbas.2E928CEC
Databáza: BASE
Popis
Abstrakt:OBJECTIVE: To study whether noninvasive pressure support ventilation (NIPSV) with helium/oxygen (He/oxygen), which can reduce dyspnea, PaCO2, and work of breathing more than NIPSV with air/oxygen in decompensated chronic obstructive pulmonary disease, could have beneficial consequences on outcome and hospitalization costs. DESIGN: Prospective, randomized, multicenter study. SETTING: Intensive care units of three tertiary care university hospitals. PATIENTS: All patients with chronic obstructive pulmonary disease admitted to the intensive care units for NIPSV during a 24-month period. INTERVENTIONS: Patients were randomized to NIPSV with air/oxygen or He/oxygen. NIPSV settings, number of daily trials, decision to intubate, and intensive care unit and hospital discharge criteria followed standard practice guidelines. RESULTS: A total of 123 patients (male/female ratio, 71:52; age, 71 +/- 10 yrs, Acute Physiology and Chronic Health Evaluation II, 17 +/- 4) were included. Intubation rate (air/oxygen 20% vs. He/oxygen 13%) and length of stay in the intensive care unit (air/oxygen 6.2 +/- 5.6 vs. He/oxygen 5.1 +/- 4 days) were comparable. The post-intensive care unit hospital stay was lower with He/oxygen (air/oxygen 19 +/- 12 vs. He/oxygen 13 +/- 6 days, p < .002). Cost of NIPSV gases was higher with He/oxygen, but total hospitalization costs were lower by $3,348 per patient with He/oxygen. No complications were associated with the use of He/oxygen. CONCLUSION: He/oxygen did not significantly reduce intubation rate or intensive care unit stay, but hospital stay was shorter and total costs were lower. He/oxygen NIPSV can be safely administered and could prove to be a cost-effective strategy.
ISSN:00903493
DOI:10.1097/01.CCM.0000055369.37620.EE