Helium-oxygen mixture in the treatment of postextubation stridor in pediatric trauma patients.

OBJECTIVE

To assess the effectiveness of a helium-oxygen mixture in reducing post-extubation stridor in children hospitalized for burns or trauma.

DESIGN

Randomized, controlled crossover trial.

SETTING

Harborview Medical Center's Burn and Trauma ICUs from March to September 1989.

PATIENTS

Children less than 15 yr old who were electively extubated and had symptoms of postextubation stridor, but required less than or equal to 35% oxygen.

INTERVENTION

Each treatment (helium-oxygen and oxygen-supplemented room air) was given in random order for 15 min after extubation.

MEASUREMENTS

Respiratory distress was assessed by a physician blinded to treatment order using a standard stridor score and clinical judgment.

RESULTS

There were 13 children with 15 extubations; seven (47%) of 15 patients required subsequent treatment with racemic epinephrine or reintubation. Stridor scores were lower with helium-oxygen than with oxygen-supplemented room air (2.8 vs. 3.7, p less than .005), and helium-oxygen was preferred in eight of nine trials in which one treatment was clearly favored by the physician.

CONCLUSION

Because helium-oxygen therapy can reduce stridor scores and is clinically preferred by physicians caring for stridorous children, it may be a useful adjunctive therapy in pediatric trauma patients with postextubation stridor.