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Devices and Delivery Part II

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In 1868, helium was first discovered during a solar eclipse. ... Treat postextubation stridor. Vocal cord dysfunction. Upper airway obstruction ... – PowerPoint PPT presentation

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Title: Devices and Delivery Part II


1
Devices and DeliveryPart II
2
GVT Asthma COPD
Helium
BACKGROUND
  • In 1868, helium was first discovered during a
    solar eclipse.
  • In 1895, Ramsay isolates helium from the mineral
    cleavite.
  • In 1923, Cooke realized that helium had a
    solubility coefficient half that of nitrogen and
    twice the diffusibility.
  • In 1926, Sayers and Yant demonstrated that
    animals could be decompressed in one third the
    time, down from a pressure of 10 atmospheres
    using helium oxygen mixtures as opposed to using
    nitrogen oxygen mixtures.
  • In 1935, Barach publishes an article on the use
    of helium in the treatment of asthma and upper
    airway obstructions.

3
GVT Asthma COPD
Helium
PROPERTIES
  • Helium is an inert colorless, odorless gas gas
    with no direct pharmacological or biological
    effects. The benefit of helium lies in the
    difference in its density as compared to other
    gases. The density of helium is one seventh that
    of air. Helium has the lowest density of any gas
    except hydrogen and, unlike hydrogen, is
    nonflammable. Equally important, carbon dioxide
    diffuses through helium four to five times faster
    than air.

4
GVT Asthma COPD
Helium
SOURCES
  • Non-renewable natural resource
  • Comes from natural gas wells
  • Majority comes from Amarillo, Texas
  • Other well sites include Saskatchewan and areas
    near the Dead Sea
  • Present in the atmosphere at approximately 1
    part in 200,000

5
Helium Oxygen
DENSITY CONSIDERATIONS
  • Oxygen at a 100 concentration has a density of
    1.43 g/L
  • Helium at a 100 concentration has a density of
    0.18 g/L
  • Helium oxygen at an 80/20 mixture has a
    density of 0.43 g/L
  • Thus, an 80/20 helium oxygen mixture is 1.8
    times less dense than 100 oxygen

6
Helium Oxygen
CLINICAL BENEFITS
7
Helium Oxygen
WOLFSON, J PEDIATRICS, 1984
  • Because heliox is less dense than air, the
    resulting decrease in the density of the
    carrier gas and decreased resistance to gas
    flow may result in an increase in bulk gas flow,
    oxygen flow, and decreased work of breathing.

8
Helium Oxygen
INDICATIONS
  • Acute asthma
  • Treat refractory croup
  • Bronchiolitis - RSV (Respiratory Syncytial
    Virus)
  • Treat postextubation stridor
  • Vocal cord dysfunction
  • Upper airway obstruction
  • Ventilatory support for obstructive defects

9
Helium Oxygen
AEROSOL THERAPY
What is an Aerosol?
  • Particle Deposition
  • Very large in size are filtered in nose
  • 100 microns
  • Large - in throat
  • 10 - 20 microns
  • Medium - in small airways
  • 2 - 5 microns
  • Small - in alveoli
  • 1 - 3 microns

10
Helium Oxygen
AEROSOL THERAPY
  • Aerosol Density and Deposition
  • Density is mass / volume
  • Typical units are milligrams per liter (mg/L)
  • Factors that Influence Deposition
  • Inertial Impaction
  • Ability to make the turn
  • Gravity
  • Particle Characteristic
  • Shape, charge, hygroscopic properties
  • Breathing Pattern
  • Normal slow breathing with occasional
    breath-hold

11
Helium Oxygen
AEROSOL THERAPY
12
Helium Oxygen
AEROSOL THERAPY
13
Helium Oxygen
AEROSOL THERAPY
  • Types of Nebulizers
  • Small Volume Nebulizers
  • Large Volume or Continuous Nebulizers
  • Ultrasonic
  • Metered Dose Inhalers
  • Vibrating Mesh Nebulizers
  • Micro Nebulizers

14
Helium Oxygen
AEROSOL THERAPY
  • Volume Output
  • Amount of liquid nebulized into the air per time
  • Normal breathing treatment with small volume
    nebulizers (SVN) last approximately ten minutes
  • Need to put in at least 3 mL of fluid into the
    nebulizer
  • Large Volume Nebulizers can last several hours
  • Can use from 9 to 200 mL of fluid within the
    nebulizer (therapist does the calculations)

15
Helium Oxygen
16
Helium Oxygen
17
Helium Oxygen
AEROSOL THERAPY
  • Ultrasonic Nebulization
  • Introduced in 1960s
  • Uses piezo-electric effect
  • crystal that converts electricity to sound waves
    that results in a real fine aerosol mist
  • Rarely used in hospitals today
  • not proven superior to SVNs
  • Is more popular as a home / portable unit

18
Helium Oxygen
  • Ultrasonic Nebulizer

19
Helium Oxygen
AEROSOL THERAPY
  • Metered Dose Inhaler (MDI)
  • Pressurized canister
  • Steps for use
  • Assemble apparatus
  • Shake
  • Exhale
  • Place holding chamber in mouth
  • Activate canister
  • Inhale slowly and hold breath for 5 to 10 seconds

20
Helium Oxygen
  • Metered Dose Inhaler

21
  • Metered Dose Inhaler Spacers

22
  • Metered Dose Inhaler Spacers

23
The Aeroneb Professional Nebulizer System is the
first major technological advance in 20 years
specifically designed for patients requiring
aerosolized therapy while on mechanical
ventilation. It improves drug delivery efficiency
and offers the potential to reduce drug and
personnel costs associated with in-patient
treatment while maintaining the integrity of
ventilator-dependent care.
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KASS, CHEST, 1999
  • 23 adult pts with asthma in ED setting
  • Prospective, randomized, controlled trial
  • He-O2 70/30 vs. N2-O2 70/30

Both groups received methylprednisolone 125 mg
IV inhaled albuterol 2.5 mg nebs x 2
After 20 minutes of therapy Heliox group PEF ?
58.4 N2-O2 group PEF ? 10.1
26
KRESS, AJRCCM, 2002
  • Adult pts in ED for asthma (n 45)
  • Randomized Heliox 80/20 vs. 100 Oxygen

3 consecutive albuterol neb treatments (0.5 cc
each) given over 90 min.
Increase in FEV1, control vs. heliox 1st Tx
14.6 vs. 32.4 2nd Tx 22.7 vs. 51.5
3rd Tx 26.7 vs. 65.1
27
CONSIDERATIONS
  • Although heliox may be a valuable tool in the
    treatment of airway pulmonary problems, it has
    no inherent therapeutic effects.
  • Helium conducts heat much more readily than does
    nitrogen. (Heat loss? - humidify and warm)
  • It should be used only as a temporary solution
    to allow time for
  • The effect of therapeutic agents to take hold
  • the natural resolution of the disease process or
    condition to occur
  • To buy time for adequate planning in dealing with
    difficult airway problems

28
CONSIDERATIONS
  • Pure 100 helium should never be used.
  • 70/30 helium oxygen mixtures are also
    popular.
  • Effort should be made to deliver the maximum
    amount of helium while maintaining the patients
    oxygen saturation level above 90.
  • If the patient requires greater than 40 oxygen,
    heliox therapy will most likely not be effective.

29
MODES OF DELIVERY
  • Non-rebreather mask
  • Non-rebreather mask with a small volume nebulizer
  • Large volume nebulizer
  • Conventional mechanical ventilation
  • High frequency oscillator (HFOV)
  • FDA clearance
  • High flow nasal cannula
  • Micro pump nebulizer
  • Non-invaisive pressure device
  • Mechanical ventilator

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AVEA Comprehensive Ventilator
  • AVEA is the first generation of integrated life
    support systems meeting the needs of all
    neonatal, pediatric, and adult patients.
  • AVEA is the first safe, reliable solution for
    Heliox delivery. AVEA's internal blending system
    automatically compensates for the gas mixture
    providing unwavering accuracy in all delivered
    and monitored parameters as well as graphic data.
  • AVEA streamlines Heliox delivery. Patients
    suffering from COPD and Asthma have benefited
    clinically from Heliox therapy.
  • AVEA has the ability to deliver non-invasive
    ventilation with Heliox to adult and pediatric
    patients. Clinical data from peer-reviewed
    journals suggests non-invasive ventilation can
    potentially reduce length of stay and
    complications.
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