I first encountered Heliox when working in ICU and assuming care of a patient with severe asthma. As the team brought her up from the emergency room, I saw the respiratory therapists pushing a huge cart with what looked like gigantic oxygen tanks. The patient was wearing an oxygen mask hooked up to these tanks via long tubing and working hard to breathe. As I would learn later, she was on Heliox and it made the difference between ending up on ventilator or improving enough to downgrade to telemetry the next day. Which she did. Go us!
What is Heliox?
Heliox is a mixture of gases that is actually used a lot in diving. As the name implies, it’s a mixture of helium and oxygen. Since helium is lighter than air, it moves through the constricted bronchioles more easily than does oxygen. Pretty cool, huh? You’ll typically see it started off as 21% oxygen and 79% helium, but this can all be titrated by the respiratory therapist and the helium weaned down as the patient improved.
How does Heliox help a patient with asthma?
In asthma, you need to deliver bronchodilators such as albuterol, but what if the airways are super tight and the medication can’t get down into the lungs? What do you do then? With this therapy, the medication is administered alongside the helium/oxygen mixture. Because the helium is light and can get into tight airways, it carries the medication along with it…allowing the albuterol (or whatever) to do it’s thang. In fact, it was actually used as THE asthma treatment back in the way-olden days before bronchodilators were created.
What other uses does Heliox have?
Heliox is also used in patients with large airway obstructions (tumors are common), croup or COPD. Because Heliox is easier to breathe, it reduces work of breathing meaning your patient is less likely to tire out and crump (which then requires emergent intubation).
It’s also used in the delivery of anesthesia and, outside of the medical field, it’s used in deep sea diving. So all in all, it’s pretty cool stuff.
Your patient is on Heliox for asthma. Now what?
If your patient is on Heliox for asthma, you need to:
- Monitor lung sounds. In patients with severe asthma you will can possibly hear NO wheezing because the airways are TOO tight. As things open up, you may here a NEW wheeze. Keep an eye on it as it will likely improve. If it worsens, let your RT and MD know ASAP!
- Monitor work-of-breathing. If your patient tires, then s/he will be in trouble. You’ll watch for accessory muscle use and their ability to speak. At first, they may not be able to talk at all. As their symptoms improve, they’ll be able to get out 2-3 word sentences, then longer and longer ones. Note that your patient is breathing helium…their voice is going to be altered, which may make them embarrassed about speaking. Do your best to establish trust so your patient feels they are in a safe environment.
- Limit activity. Usually this isn’t difficult to do with a patient who can’t breathe as they tend to self regulate their activity. However, in a confused patient, this isn’t always the case. People try to get up out of bed, try to take off their masks. It can be challenging!
- Monitor for hypoxia. As hypoxia ensues patients become quite agitated. If your once calm patient suddenly becomes really anxious or agitated, suspect that their O2 level is low. Get some help.
- Monitor for hypercapnia. If your patient becomes worn out, they will breathe more and more slowly and retain more and more CO2. If your once agitated or alert patient becomes somnolent to the point of being difficult to rouse, suspect elevated CO2 levels. They will need more aggressive respiratory support.
- Administer nebulized medications. Actually, this will be done by your respiratory therapist, but you want to monitor the patient for their response to these treatments.
- Keep your patient NPO. No matter how much they beg, do not give a patient in respiratory distress anything to eat or drink. The risk for aspiration is extremely high. Once they are able to speak in full sentences and have a normal respiratory rate (12 to 20-ish per minute), then you can start them off on fluids then progress.
- Plan your teaching. As your patient improves and you are able to speak with them about what precipitated this particular attack, you can determine what their teaching needs are. Do they smoke? Do they live with 18 cats and zero vacuum cleaners? Were they jogging on a windy spring day? Did their inhaler run out? Have they not seen their pulmonologist in five years?
With good nursing and respiratory care, your patient will likely improve within hours. As this occurs, your RT will wean down the Heliox. Keep a close eye on your patient, communicating any abnormal findings with your therapist. Working as a team, you’ll get your patient back to normal in no time. Way to go!