FAQ for Heliox Inhalation Therapy for Bronchiolitis
- Q: When should I consider using nasal cannula heliox inhalation therapy?
A: If you considering admitting due to respiratory distress, heliox inhalation may benefit the patient. Definitely consider it when you are admitting to the PICU or contemplating intubation. These patients appear to benefit the most. You may be able to reduce their respiratory distress significantly in a short period of time (minutes).
A simple rule of thumb: If there are sick enough to be in a critical care/resuscitation room, they probably are a good candidate for heliox inhalation therapy.
- Q: If the patient is a “happy wheezer” would you consider heliox inhalation therapy?
A: No. If they are feeding well, well appearing, and only in mild respiratory distress, heliox will not likely benefit this patient.
- Q: What settings do you start with for your patients?
A: For moderate distress: 6 LPM, 70% helium: 30% oxygen is a good starting point. If the patient’s pulse oximetry is <90%, you can go up to 8 LPM and then 10 LPM. If their respiratory distress improves, we quickly titrate down to 4 LPM and even 2 LPM.
A: For severe or extremely severe (intubatable) distress: 10 LPM, 70% helium: 30% oxygen is a good starting point. If the patient’s pulse oximetry is <90%, you can increase the oxygen concentration to 40 and even 50% (if you are on a blender). We still see clinical benefit from 60% helium: 40% oxygen and 50% helium: 50% oxygen.
- Q: What pulse oximetry range do you target?
A: 93-99%. Too much oxygen can cause atelectasis. 100% pulse oximetry may be reassuring, but we try to give them only as much supplemental oxygen as the patient needs.
- Q: If the patient needs to go for a procedure such as X-ray, what do you want done with the study patients during transport? Place on standard O2?
A: Yes, the patient can come off the Vapotherm temporarily and go on regular O2 for transport between floors or to radiology if no portable heliox tanks are available.
- Q: Can I wean the heliox inhalation therapy if the patient looks well?
A: Definitely yes, we have provided suggested weaning guides for the RTs and staff. The simplest way (if the pulse oximetry is >94%) is to wean the flow rates from 6 LPM to 4 LPM to 2 LPM to 1 LPM to off.We created laminated weaning reference guides which are hanging from the top of the pole holding the Vapotherm.
- Q: What happens if the Vapotherm alarms go off?
A: Don’t panic. Page the RT. If one is not available in reasonable amount of time, one can contact the RTs in the NICU, PICU, or ED. Most have experience troubleshooting the simple problems. The most likely reasons for alarms: the sterile water bag needs refilling or the heliox tank needs changing.
If the pulse oximetry > 94%, one can turn off the Vapotherm until RT help arrives. If the patient requires supplemental O2, one can put the patient on standard O2 via NC.
- Q: Is there anything different that the admit teams need to do for patients on heliox inhalation therapy?
A: We have started asking the admit teams to order Nasal Cannula for O2 at bedside (similar to what we do for seizure precaution patients) in case a floor RT cannot respond quickly to troubleshoot any issues. This safe approach gives us a temporary fallback system in the busy respiratory season.
i These clinical questions and answers are not intended to be construed or to serve as a standard of medical care. Rather, it is intended to serve as a guideline and promote coordination and communication with respect to patient care and may be modified to meet individual care needs.