Heliox as the Rescue Therapy for a Neonate with Congenital Tracheal Stenosis, Pulmonary Artery Sling, and Intracardiac Anomalies

ABSTRACT

Congenital tracheal stenosis (CTS) is a rare disease associated with high mortality and morbidity, especially if it is associated with intracardiac anomalies or vascular rings. Heliox, a “carrier gas” with low density, has been used in pediatric intensive care units for treating acute respiratory failure due to obstructive airway disease. Here we report a 3100-g, 39-week newborn with long-segment CTS complicated with a pulmonary artery sling and tetralogy of Fallot, to whom heliox was given as the rescue therapy during near-complete airway obstruction and cardiopulmonary failure. Although this patient finally died from failure of corrective surgery, our experience with heliox has suggested that its effects in improving oxygenation and eliminating CO₂ can be a rescue strategy in a mechanically ventilated infant with severe airway obstruction.

Congenital tracheal stenosis - pulmonary artery sling - tetralogy of Fallot - heliox - cardiopulmonary failure

REFERENCES

• 1 Benjamin B, Pitken J, Cohen D. Congenital tracheal stenosis.  Ann Otol Rhinol Laryngol. 1981;  90 364-371
• 2 Loeff D S, Filler R M, Vinograd I et al.. Congenital tracheal stenosis: a review of 22 patients from 1965 to 1987.  J Pediatr Surg. 1988;  23 744-748
• 3 Wong K S, Lan R S, Liu H P, Lin T Y. Congenital tracheal stenosis: report of six cases.  Changgeng Yi Xue Za Zhi. 1995;  18 365-370
• 4 Cohen S R, Landing B H. Tracheostenosis and bronchial abnormalities associated with pulmonary artery sling.  Ann Otol Rhinol Laryngol. 1976;  85 582-588
• 5 Barach A. The use of helium in the treatment of asthma and obstructive lesions in the larynx and trachea.  Ann Intern Med. 1935;  9 739-765
• 6 Wigmore T, Stachowski E. A review of the use of heliox in the critically ill.  Crit Care & Resusc. 2006;  8 64-72
• 7 Myers T R. Use of heliox in children.  Respir Care. 2006;  51 619-631
• 8 Fink J B. Opportunities and risks of using heliox in your clinical practice.  Respir Care. 2006;  51 651-660
• 9 Gupta V K, Cheifetz I M. Heliox administration in the pediatric intensive care unit: an evidence-based review.  Pediatr Crit Care Med. 2005;  6 204-211
• 10 Gentile M A. The role of inhaled nitric oxide and heliox in the management of acute respiratory failure.  Respir Care Clin N Am. 2006;  12 489-500
• 11 Kim H K, Kim Y T, Sung S W et al.. Management of congenital tracheal stenosis.  Eur J of Cardiothoracic Surg. 2004;  25 1065-1071
• 12 Hess D R, Fink J B, Venkataraman S T, Kim I K, Myers T R, Tano B D. The history and physics of heliox.  Respir Care. 2006;  51 608-612
• 13 Venkataraman S T. Heliox during mechanical ventilation.  Respir Care. 2006;  51 632-639
• 14 Kudukis T M, Manthous C A, Schmidt G A, Hall J B, Wylam M E. Inhaled helium-oxygen revisited: effect of inhaled helium-oxygen during the treatment of status asthmaticus in children.  J Pediatr. 1997;  130 217-224
• 15 Winters J W, Willing M A, Sanfilippo D. Heliox improves ventilation during high-frequency oscillatory ventilation in pediatric patients.  Pediatr Crit Care Med. 2000;  1 33-37
• 16 Gross M F, Spear R M, Peterson B M. Helium-oxygen mixture does not improve gas exchange in mechanically ventilated children with bronchiolitis.  Crit Care. 2000;  4 188-192
• 17 Kneyber M C, van Heerde M, Markhorst D G, Plötz F B. Mechanical ventilation with heliox decreases respiratory system resistance and facilitates CO2 removal in obstructive airway disease.  Intensive Care Med. 2006;  32 1676-1677