Is heliox effective in the treatment of croup?

Updated: Oct 09, 2019
  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Russell W Steele, MD  more...
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Heliox is a gas that contains a mixture of helium and oxygen (with not less than 20% oxygen). Delivery to the patient is via nasal cannula, face mask, or hood. It has low viscosity and low specific gravity, which allows for greater laminar airflow through the respiratory tract. Helium facilitates the movement of oxygen through the airways and decreases the mechanical work of respiratory muscles. This clinical response reduces respiratory distress. [39, 40]

Several trials of heliox have demonstrated no advantage over conventional modalities; however, other trials have shown it to be equally effective in moderate to severe croup when compared with racemic epinephrine. [41, 42, 43] Heliox has also been shown to improve symptoms in very severe croup that failed to improve with nebulized racemic epinephrine. Currently, the evidence is not sufficient to establish the beneficial effect of heliox in pediatric croup management. [44]  However, heliox has been used during emergency transport of children with severe croup. Anecdotal evidence suggests that heliox does help relieve respiratory distress. [45]

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