COPD exacerbation: the benefits of heliox are unclear

Clinical bottom line (level 1a-)

  1. Patients with COPD exacerbations who receive heliox compared with air or oxygen do not clearly have any clinical significant benefits.
Rodrigo et al: Cochrane Library 2000; 4 : -
Expires June 2004

The study

Systematic review of all randomised controlled trials of
  • Patients: exacerbation of chronic obstructive pulmonary disease (COPD)
  • Intervention: heliox (helium-oxygen) compared with oxygen or air
  • Outcome: pulmonary function, admission to hospital

Articles found in all languages using Cochrane Airways Review Group asthma register (including Medline, Embase, CINAHL and hand-searches of 20 respiratory journals), 1966 to November 2000 (search terms: detailed in text ) and searching reference lists of retrieved articles and reviews. Experts in the field, manufacturers and authors were also contacted.

Selection criteria: by 2 independent reviewers with disagreements resolved by a third reviewer and consensus
Appraisal criteria: by 2 independent reviewers with disagreements resolved by a third reviewer and consensus using Jadad criteria
Articles excluded if:
  • patients aged < 18
  • patients mainly with asthma
  • stable COPD

4 RCTs found
  • 2 involving decompensated COPD patients who were not ventilated
  • 1 involving mechanically ventilated patients
  • 1 involving patients receiving noninvasive pressure support ventilation
Data was available for only 2 studies.

The evidence

  • Non-invasive pressure support: heliox led to improved dyspnoea scores (p < 0.05) and greater falls in pCO2 levels (p < 0.05)
  • Decompensated COPD receiving nebulisers driven by heliox or air. No difference in FEV1 or FVC was noted between the two groups after 1 or 2 hours

Citation

  1. Rodrigo G, Pollack C, Rodrigo C, et al: heliox for treatment of exacerbations of chronic obstructive pulmonary disease. Cochrane Library 2000; 4 : -
Search Terms: from ACP Journal Club other articles ntoed
Contributor: Chris Ball, June 2002
Reviewer:

Clinical Question.
Patient COPD exacerbation
Intervention or Exposure heliox (helium-oxygen)
Comparison air or oxygen
Outcome pulmonary function