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Policies,Clinical,UWHC Clinical,Department Specific,Respiratory Care Services,Special Procedures

Heliox (3.52)

Heliox (3.52) - Policies, Clinical, UWHC Clinical, Department Specific, Respiratory Care Services, Special Procedures

3.52



3.52 Heliox
Category: UWHC Departmental Policy
Effective Date: November 1, 2015
Version: Revision
Manual: Respiratory Care Services
Section: Special Procedures


I. DESCRIPTION

Helium is an odorless, tasteless, non-combustible, and non-explosive gas. The density of helium is one-third the
density of air. With normal respiration, the flow of gas is laminar and depends on the viscosity, not the density.
With an obstruction, there is turbulence and energy is spent relative to density. Based on the Bernoulli affect,
with a decrease in airway caliber, gas velocity will increase causing a pressure drop distal to the obstruction.
Due to helium’s low density, less driving pressure is required, and at the same velocity, there is a smaller drop in
pressure providing more laminar flow and less turbulence, improving overall ventilation.

II. POLICY

A. All patients will be assessed by the Respiratory Care Practitioner (RCP) to determine if the appropriate
indications for the therapy are present.
B. Therapy will be provided in accordance with a provider's order.
C. Patients must be in an ICU or IMC with continuous pulse oximetry monitoring.
D. Heliox can only be used with the Servo i and non-rebreather masks.
E. All heliox set-ups will have a compatible oxygen analyzer in line at all times with high and low FIO
2

alarm.
F. For non-ventilated patients fitted masks should have a total liter flow equal to three times the patient’s
minute ventilation.
G. Medical grade heliox concentration should not exceed 80% - 20% to prevent hypoxia, and should not fall
below 50%, as the benefits diminish.
H. Use the smallest amount of helium possible to meet FiO
2
and patient demands.

III. EQUIPMENT

A. Oxygen analyzer that is compatible with helium and has high and low FiO2 alarms.
B. Medical grade 80/20 Heliox cylinder with label on the front, with regulator for Servo i.
C. Medical grade 80/20 Heliox cylinder with Heliox blender on pole with regulators for large and small
cylinders.
1. Adult non-rebreather mask.
2. Pediatric re-breather mask with adult non-rebreather bag.
3. Hi-ox mask (adult or pediatric) for patients requiring continuous nebulization (see P&P 2.33
Continuous Nebulized Aerosols).
4. High Flow Nasal Cannula in AFCH (see related link).
D. E cylinders will only be used for transport and emergency set-ups.
E. H cylinders will be used for continuous helium delivery.

IV. PROCEDURE

A. Review and acknowledge provider's order.
B. Review patient's chart.
C. Obtain the appropriate equipment.
D. Introduce yourself to the patient and/or family. Explain the reason for the procedure.
E. Assess the patient throughout the procedure.
F. Intubated Patients.
1. Servo i labeled for Heliox use. See related link.
2. Attach the air supply line from the ventilator to the helium/oxygen regulator

(the quick connect will need to be removed).
3. Turn the tank on. Once ventilation starts, a window pops up stating “an upgrade is needed to
make Heliox compatible and to ensure accurate performance. Contact your Maquet
representative.” DISREGARD THIS COMMENT & PRESS OK.
4. Expired tidal volumes (Vt) on the ventilator LED will be inaccurate. Monitor inspired LED tidal
volumes.
5. With pressure ventilation, peak airway pressures should decrease due to laminar flow.
Decrease preset pressures to obtain the same inspiratory Vt.
6. Analyze set FiO2 with an external analyzer placed on the inspiratory outlet from the ventilator.
Alarms should be set +/-5 from the desired FiO2.
G. Non-intubated Patients
1. Use the dual flowmeter – heliox blender pole with appropriate regulator.
2. One flowmeter attaches to an oxygen analyzer for continuous monitoring.
3. Conversion chart is available on the Heliox blender for corrected Heliox flow at various FiO2
Settings.
4. Non-rebreather set-up. (see related link). Attach the NRB mask set-up to available flowmeter
with sufficient flow to keep the bag inflated.

V. REFERENCES

A. RC P&P 2:33 "Continuous Nebulized Aerosols"
B. Egan: Fundamentals of Respiratory Care


Approved by Director and Medical Director of Respiratory Care
A copy of this Policy & Procedure is available in the Respiratory Care Office [E5/489].