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

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Abstract
To assess the effectiveness of a helium-oxygen mixture in reducing post-extubation stridor in children hospitalized for burns or trauma. Randomized, controlled crossover trial. Harborview Medical Center's Burn and Trauma ICUs from March to September 1989. 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. Each treatment (helium-oxygen and oxygen-supplemented room air) was given in random order for 15 min after extubation. Respiratory distress was assessed by a physician blinded to treatment order using a standard stridor score and clinical judgment. 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. 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.

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