A multicenter, randomized trial of noninvasive ventilation with helium-oxygen mixture in exacerbations of chronic obstructive lung disease

Crit Care Med. 2010 Jan;38(1):145-51. doi: 10.1097/CCM.0b013e3181b78abe.


Objective: To assess the effect of a helium-oxygen mixture on intubation rate and clinical outcomes during noninvasive ventilation in acute exacerbation of chronic obstructive pulmonary disease.

Design: Multicenter, prospective, randomized, controlled trial.

Setting: Seven intensive care units.

Patients: A total of 204 patients with known or suspected chronic obstructive pulmonary disease and acute dyspnea, Paco2> 45 mm Hg and two among the following factors: pH <7.35, Paco2 <50 mm Hg, respiratory rate >25/min.

Interventions: Noninvasive ventilation randomly applied with or without helium (inspired oxygen fraction 0.35) via a face mask.

Measurements and main results: Duration and complications of NIV and mechanical ventilation, endotracheal intubation, discharge from intensive care unit and hospital, mortality at day 28, adverse and serious adverse events were recorded. Follow-up lasted until 28 days since enrollment. Intubation rate did not significantly differ between groups (24.5% vs. 30.4% with or without helium, p = .35). No difference was observed in terms of improvement of arterial blood gases, dyspnea, and respiratory rate between groups. Duration of noninvasive ventilation, length of stay, 28-day mortality, complications and adverse events were similar, although serious adverse events tended to be lower with helium (10.8% vs. 19.6%, p = .08).

Conclusions: Despite small trends favoring helium, this study did not show a statistical superiority of using helium during NIV to decrease the intubation rate in acute exacerbation of chronic obstructive pulmonary disease.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Blood Gas Analysis
  • Critical Care / methods
  • Female
  • Helium / therapeutic use*
  • Humans
  • Intensive Care Units
  • Length of Stay
  • Male
  • Masks
  • Middle Aged
  • Oxygen / therapeutic use
  • Oxygen Inhalation Therapy / methods*
  • Probability
  • Prognosis
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive / diagnosis*
  • Pulmonary Disease, Chronic Obstructive / therapy*
  • Pulmonary Gas Exchange
  • Recurrence
  • Respiration, Artificial / methods
  • Respiratory Function Tests
  • Risk Assessment
  • Severity of Illness Index
  • Treatment Outcome


  • Helium
  • Oxygen