Congress Abstracts 2006

39

DON'T FORGET TO LIGHTEN UP: HELIOX THERAPY FOR UPPER AIRWAY OBSTRUCTIONS. Gina Domenick, BSN, RN, and Marie Swisher, MSN, RN, Johns Hopkins Hospital-SKCCC, Baltimore, MD.

Dyspnea is the fifth most common and sixth most distressing symptom experienced by patients with cancer. Oxygen therapy is a common treatment for dyspnea although not always effective. Upper airway obstructions, such as malignant masses or severe mucositis may decrease the effectiveness of oxygen therapy. Combining oxygen and helium, heliox, may improve oxygenation and decrease ventilatory effort. When an obstruction is present in upper airways, gas flow becomes erratic, causing turbulent airflow with hypoxemia and increased respiratory effort. Helium offers low density properties allowing it to circulate around airway obstructions; improving oxygen delivery. Historically, heliox has been used in pediatric patients to treat asthma and post extubation stridor, although there is growing evidence supporting its application in adults.

The purpose of this presentation is to provide an overview of nursing care of the patient receiving heliox therapy using a case exemplar. The presentation includes pathophysiology of upper airway obstructions, their clinical presentation, and nursing care for patients receiving heliox.

Through specific case discussion, the presentation highlights ideal patient selection for this therapy, clinical care, and patient education. The interdisciplinary efforts of nurses, oncologists, pulmonologists, anesthesiologists, and respiratory therapists can optimize administration of this novel therapy.

This presentation explores the clinical application of a new type of oxygen therapy designed to abrogate dyspnea, and enhance oxygenation in patients with upper airway obstruction. It can be used to prevent the need for insertion of an artificial airway, or to provide symptomatic support at end of life. It requires the support of respiratory therapy and specialized nurse care.

Heliox can improve oxygenation while patients are waiting for other invasive interventions to take effect. Intubation and ventilatory assistance may be contraindicated due to patients' advanced directives and advanced disease processes. The application of heliox as a type of non-invasive ventilation may allow more time to discuss code status with patients and families who have not completed advanced directives. Heliox can reduce air hunger and provide comfort at end of life.