Helium–oxygen ventilation in the presence of expiratory flow-limitation: A model study

• Published in: Respiratory physiology & neurobiology Vol. 157; no. 2; pp. 326 - 334
• Main Authors: Brighenti, Chiara, Barbini, Paolo, Gnudi, Gianni, Cevenini, Gabriele, Pecchiari, Matteo, D’Angelo, Edgardo
• Format: Journal Article
• Language: English
• Published: Amsterdarm Elsevier B.V 01.08.2007; Elsevier
• Subjects: Airway collapsibility; Biological and medical sciences; Chronic obstructive pulmonary disease; Chronic obstructive pulmonary disease, asthma; Dynamic hyperinflation; Flow–volume curve; Forced Expiratory Flow Rates - drug effects; Fundamental and applied biological sciences. Psychology; Helium - administration & dosage; Humans; Inspiratory Capacity - drug effects; Lung Volume Measurements - methods; Mathematical model; Mathematics; Medical Education; Medical sciences; Models, Biological; Nonlinear Dynamics; Oxygen - administration & dosage; Pneumology; Pulmonary/Respiratory; Respiration, Artificial - methods; Vertebrates: respiratory system; Airway collapsibility; Chronic obstructive pulmonary disease; Flow–volume curve; Mathematical model; Dynamic hyperinflation; Flow-volume curve; Lung disease; Oxygen; Hyperinflation; Respiratory disease; Helium; Respiratory system; Respiratory tract; Vertebrata; Chronic; Mammalia; Bronchus disease; Obstructive pulmonary disease; Pulmonary ventilation; Respiration
• ISSN: 1569-9048; 1878-1519
• DOI: 10.1016/j.resp.2006.12.012

Abstract A comparison between air and heliox (80% helium–20% oxygen) ventilation was performed using a mathematical, non-linear dynamic, morphometric model of the respiratory system. Different obstructive conditions, all causing expiratory flow limitation (EFL), were simulated during mechanical ventilation to evaluate and interpret the effects of heliox on tidal EFL and dynamic hyperinflation. Relative to air ventilation, intrinsic positive end-expiratory pressure did not change with heliox if the obstruction was limited to the peripheral airways, i.e. beyond the seventh generation. When central airways were also involved, heliox reduced dynamic hyperinflation (DH) if the flow-limiting segment remained in the fourth to seventh airway generation during the whole expiration, but produced only minor effects if, depending on the contribution of peripheral to total apparent airway resistance, the flow-limiting segment moved eventually to the peripheral airways. In no case did heliox abolish EFL occurring with air ventilation, indicating that any increase in driving pressure would be without effect on DH. Hence, to the extent that chronic obstructive pulmonary disease (COPD) affects primarily the peripheral airways, and causes EFL through the same mechanisms operating in the model, heliox administration should not be expected to appreciably reduce DH in the majority of COPD patients who are flow-limited at rest.