Breathing a hydrogen-oxygen mixture reduces inspiratory effortScientific Research

Breathing Hydrogen-Oxygen Mixture Decreases Inspiratory Effort in Patients with Tracheal Stenosis

Zhou Z.-Q.a · Zhong C.-H.a · Su Z.-Q.a · Li X.-Y.b · Chen Y.a · Chen X.-B.a · Tang C.-L.a · Zhou L.-Q.a · Li S.-Y.a

https://doi.org/10.1159/000492031

Abstract

Background

Hydrogen-oxygen (H2-O2) mixtures reduce airway resistance in patients with acute severe tracheal stenosis, but data to support the clinical use of H2-O2 are insufficient.

Objective

To evaluate the efficacy and safety of H2-O2 breathing in the treatment of acute severe tracheal stenosis. Methods: Thirty-five consecutive patients with severe acute tracheal stenosis were recruited for this prospective, self-controlled study. Air, H2-O2 and O2 inhalation divided into 4 consecutive breaths: air for 15 minutes, H2-O2 (6 L/min, H2:O2 = 2:1) for 15 minutes, oxygen (3 L/min) for 15 minutes and H2- O2 120 minutes. The primary endpoint was inspiratory effort as assessed by diaphragm electromyography (EMGdi); secondary endpoints were transdiaphragmatic pressure (Pdi), Borg score, vital signs, and pulse oscillography (IOS). The concentration of H2 in the environment was obtained by 12 monitors.Side effects during inhalation were recorded.

Results

The mean reduction in EMGdi under H2-O2 was 10.53 ± 6.83%. EMGdi decreased significantly (52.95 ± 15.00 vs 42.46 ± 13, 90 vs 53.20 ± 14.74 vs 42.50) during 2 H2-O2 inhalation steps (steps 2 and 4) compared to air (step 1) and O2 (step 3) ± 14.12% for steps 1 to 4, p<0.05). The mean reduction in Pdi under H2-O2 was 4.77 ± 3.51 cmH2O. H2-O2 respiration significantly improved Borg scores and IOS resistance parameters, but not vital signs. no side effects. During the entire process, no H2 was detected in the environment.

Conclusions

H2-O2 inhalation reduces inspiratory effort in patients with acute severe tracheal stenosis and can be used safely for this purpose.

 

References

    1. Rahman NA, Fruchter O, Shitrit D, Fox BD, Kramer MR: Flexible bronchoscopic management of benign tracheal stenosis: long term follow-up of 115 patients. J Cardiothorac Surg 2010; 5: 2.

    1. Thornton RH, Gordon RL, Kerlan RK, LaBerge JM, Wilson MW, Wolanske KA, Gotway MB, Hastings GS, Golden JA: Outcomes of tracheobronchial stent placement for benign disease. Radiology 2006; 240: 273–282.

    1. Bo L, Li C, Chen M, Mu D, Jin F: Application of electrocautery needle knife combined with balloon dilatation versus balloon dilatation in the treatment of tracheal fibrotic scar stenosis. Respiration 2018; 95: 182–187.

    1. Skrinskas GJ, Hyland RH, Hutcheon MA: Using helium-oxygen mixtures in the management of acute upper airway obstruction. Can Med Assoc J 1983; 128: 555–558.

    1. Jaber S, Carlucci A, Boussarsar M: Helium-oxygen in the postextubation period decreases inspiratory effort. Am J Respir Crit Care Med 2001; 164: 633–637.

    1. Rodeberg DA, Easter AJ, Washam MA, Housinger TA, Greenhalgh DG, Warden GD: Use of a helium-oxygen mixture in the treatment of postextubation stridor in pediatric patients with burns. J Burn Care Rehabil 1995; 16: 476–480.

    1. Kemper KJ, Ritz RH, Benson MS, Bishop MS: Helium-oxygen mixture in the treatment of postextubation stridor in pediatric trauma patients. Crit Care Med 1991; 19: 356–359.

    1. Boorstein JM, Boorstein SM, Humphries GN, Johnston CC: Using helium-oxygen mixtures in the emergency management of acute upper airway obstruction. Ann Emerg Med 1989; 18: 688–690.

    1. Peng Z, Chen W, Wang L, Ye Z, Gao S, Sun X, Guo Z: Inhalation of hydrogen gas ameliorates glyoxylate-induced calcium oxalate deposition and renal oxidative stress in mice. Int J Clin Exp Pathol 2015; 8: 2680–2689.

    1. Cui J, Chen X, Zhai X, Shi D, Zhang R, Zhi X, Li X, Gu Z, Cao L, Weng W, Zhang J, Wang L, Sun X, Ji F, Hou J, Su J: Inhalation of water electrolysis-derived hydrogen ameliorates cerebral ischemia-reperfusion injury in rats – a possible new hydrogen resource for clinical use. Neuroscience 2016; 335: 232–241.

    1. Li H, Chen O, Ye Z, Zhang R, Hu H, Zhang N, Huang J, Liu W, Sun X: Inhalation of high concentrations of hydrogen ameliorates liver ischemia/reperfusion injury through A2A receptor mediated PI3K-Akt pathway. Biochem Pharmacol 2017; 130: 83–92.

    1. Liu X, Ma C, Wang X, Wang W, Li Z, Wang X, Wang P, Sun W, Xue B: Hydrogen coadministration slows the development of COPD-like lung disease in a cigarette smoke-induced rat model. Int J Chron Obstruct Pulmon Dis 2017; 12: 1309–1324.

    1. Gong ZJ, Guan JT, Ren XZ, Meng DY, Zhang HR, Wang BL, Yan XX: [Protective effect of hydrogen on the lung of sanitation workers exposed to haze]. Zhonghua Jie He He Hu Xi Za Zhi 2016; 39: 916–923.

    1. Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Chen R, Decramer M, Fabbri LM, Frith P, Halpin DM, Lopez Varela MV, Nishimura M, Roche N, Rodriguez-Roisin R, Sin DD, Singh D, Stockley R, Vestbo J, Wedzicha JA, Agusti A: Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary. Am J Respir Crit Care Med 2017; 195: 557–582.

    1. Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG: CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ 2010; 340:c869.

    1. Freitag L, Ernst A, Unger M, Kovitz K, Marquette CH: A proposed classification system of central airway stenosis. Eur Respir J 2007; 30: 7–12.

    1. Wang R, Wu J, Chen Z, Xia F, Sun Q, Liu L: Postconditioning with inhaled hydrogen promotes survival of retinal ganglion cells in a rat model of retinal ischemia/reperfusion injury. Brain Res 2016; 1632: 82–90.

    1. Xiao SC, He BT, Steier J, Moxham J, Polkey MI, Luo YM: Neural respiratory drive and arousal in patients with obstructive sleep apnea hypopnea. Sleep 2015; 38: 941–949.

    1. Luo YM, Moxham J, Polkey MI: Diaphragm electromyography using an oesophageal catheter: current concepts. Clin Sci (Lond) 2008; 115: 233–244.

    1. Guan WJ, Yuan JJ, Gao YH, Li HM, Zheng JP, Chen RC, Zhong NS: Impulse oscillometry and spirometry small-airway parameters in mild to moderate bronchiectasis. Respir Care 2016; 61: 1513–1522.

    1. Bickel S, Popler J, Lesnick B, Eid N: Impulse oscillometry: interpretation and practical applications. Chest 2014; 146: 841–847.

    1. Hess DR, Fink JB, Venkataraman ST, Kim IK, Myers TR, Tano BD: The history and physics of heliox. Respir Care 2006; 51: 608–612.

    1. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med 2002; 166: 518–624.

    1. Diehl JL, Peigne V, Guerot E, Faisy C, Lecourt L, Mercat A: Helium in the adult critical care setting. Ann Intensive Care 2011; 1: 24.

    1. Liistro G, Veriter C, Stanescu D: Influence of gas density on simulated snoring. Eur Respir J 1999; 13: 679–681.

    1. Glauser SC, Glauser EM, Rusy BF: Influence of gas density and viscosity on the work of breathing. Arch Environ Health 1969; 19: 654–660.

    1. Houck JR, Keamy MF 3rd, McDonough JM: Effect of helium concentration on experimental upper airway obstruction. Ann Otol Rhinol Laryngol 1990; 99: 556–561.

    1. Liu ZD, Qiu ZH, Tan KX, Xiao SC, Liu MF, Luo YM: [Assessment of neural respiratory drive in humans]. Zhonghua Jie He He Hu Xi Za Zhi 2013; 36: 493–496.

    1. Xiao SC, Lu YR, Guo HX, Qiu ZH, Luo YM: Effect of expiratory load on neural inspiratory drive. Chin Med J (Engl) 2012; 125: 3629–3634.

    1. Tang J, Lu YR, Luo YM: [Respiratory effort assessed by surface diaphragm EMG in patients with sleep apnea]. Zhonghua Jie He He Hu Xi Za Zhi 2009; 32: 732–735.

    1. Curtis JL, Mahlmeister M, Fink JB, Lampe G, Matthay MA, Stulbarg MS: Helium-oxygen gas therapy. Use and availability for the emergency treatment of inoperable airway obstruction. Chest 1986; 90: 455–457.

    1. Mizrahi S, Yaari Y, Lugassy G, Cotev S: Major airway obstruction relieved by helium/oxygen breathing. Crit Care Med 1986; 14: 986–987.

    1. Duncan PG: Efficacy of helium – oxygen mixtures in the management of severe viral and post-intubation croup. Can Anaesth Soc J 1979; 26: 206–212.

    1. Fleming MD, Weigelt JA, Brewer V, McIntire D: Effect of helium and oxygen on airflow in a narrowed airway. Arch Surg 1992; 127: 956–959; discussion 959–960.

    1. Maggiore SM, Richard JC, Abroug F, Diehl JL, Antonelli M, Sauder P, Mancebo J, Ferrer M, Lellouche F, Lecourt L, Beduneau G, Brochard L: A multicenter, randomized trial of noninvasive ventilation with helium-oxygen mixture in exacerbations of chronic obstructive lung disease. Crit Care Med 2010; 38: 145–151.

    1. Haussermann S, Schulze A, Katz IM, Martin AR, Herpich C, Hunger T, Texereau J: Effects of a helium/oxygen mixture on individuals’ lung function and metabolic cost during submaximal exercise for participants with obstructive lung diseases. Int J Chron Obstruct Pulmon Dis 2015; 10: 1987–1997.

    1. Komarow HD, Myles IA, Uzzaman A, Metcalfe DD: Impulse oscillometry in the evaluation of diseases of the airways in children. Ann Allergy Asthma Immunol 2011; 106: 191–199.

    1. Oostveen E, MacLeod D, Lorino H, Farre R, Hantos Z, Desager K, Marchal F; Measurements ERSTFoRI: The forced oscillation technique in clinical practice: methodology, recommendations and future developments. Eur Respir J 2003; 22: 1026–1041.

    1. Vicencio AG, Bent J, Tsirilakis K, Nandalike K, Veler H, Parikh S: Management of severe tracheal stenosis using flexible bronchoscopy and impulse oscillometry. J Bronchology Interv Pulmonol 2010; 17: 162–164.

    1. Handa H, Huang J, Murgu SD, Mineshita M, Kurimoto N, Colt HG, Miyazawa T: Assessment of central airway obstruction using impulse oscillometry before and after interventional bronchoscopy. Respir Care 2014; 59: 231–240.

  1. Verbanck S, de Keukeleire T, Schuermans D, Meysman M, Vincken W, Thompson B: Detecting upper airway obstruction in patients with tracheal stenosis. J Appl Physiol (1985) 2010; 109: 47–52.
DOI: 10.1159

Published on: 18/09/2018

Authors:

Zhou ZQ, Zhong CH, Su ZQ, et al

Breathing Hydrogen-Oxygen Mixture Decreases Inspiratory Effort in Patients with Tracheal Stenosis

Zhou Z.-Q.a · Zhong C.-H.a · Su Z.-Q.a · Li X.-Y.b · Chen Y.a · Chen X.-B.a · Tang C.-L.a · Zhou L.-Q.a · Li S.-Y.a

https://doi.org/10.1159/000492031

Abstract

Background

Hydrogen-oxygen (H2-O2) mixtures reduce airway resistance in patients with acute severe tracheal stenosis, but data to support the clinical use of H2-O2 are insufficient.

Objective

To evaluate the efficacy and safety of H2-O2 breathing in the treatment of acute severe tracheal stenosis. Methods: Thirty-five consecutive patients with severe acute tracheal stenosis were recruited for this prospective, self-controlled study. Air, H2-O2 and O2 inhalation divided into 4 consecutive breaths: air for 15 minutes, H2-O2 (6 L/min, H2:O2 = 2:1) for 15 minutes, oxygen (3 L/min) for 15 minutes and H2- O2 120 minutes. The primary endpoint was inspiratory effort as assessed by diaphragm electromyography (EMGdi); secondary endpoints were transdiaphragmatic pressure (Pdi), Borg score, vital signs, and pulse oscillography (IOS). The concentration of H2 in the environment was obtained by 12 monitors.Side effects during inhalation were recorded.

Results

The mean reduction in EMGdi under H2-O2 was 10.53 ± 6.83%. EMGdi decreased significantly (52.95 ± 15.00 vs 42.46 ± 13, 90 vs 53.20 ± 14.74 vs 42.50) during 2 H2-O2 inhalation steps (steps 2 and 4) compared to air (step 1) and O2 (step 3) ± 14.12% for steps 1 to 4, p<0.05). The mean reduction in Pdi under H2-O2 was 4.77 ± 3.51 cmH2O. H2-O2 respiration significantly improved Borg scores and IOS resistance parameters, but not vital signs. no side effects. During the entire process, no H2 was detected in the environment.

Conclusions

H2-O2 inhalation reduces inspiratory effort in patients with acute severe tracheal stenosis and can be used safely for this purpose.

 

References

    1. Rahman NA, Fruchter O, Shitrit D, Fox BD, Kramer MR: Flexible bronchoscopic management of benign tracheal stenosis: long term follow-up of 115 patients. J Cardiothorac Surg 2010; 5: 2.

    1. Thornton RH, Gordon RL, Kerlan RK, LaBerge JM, Wilson MW, Wolanske KA, Gotway MB, Hastings GS, Golden JA: Outcomes of tracheobronchial stent placement for benign disease. Radiology 2006; 240: 273–282.

    1. Bo L, Li C, Chen M, Mu D, Jin F: Application of electrocautery needle knife combined with balloon dilatation versus balloon dilatation in the treatment of tracheal fibrotic scar stenosis. Respiration 2018; 95: 182–187.

    1. Skrinskas GJ, Hyland RH, Hutcheon MA: Using helium-oxygen mixtures in the management of acute upper airway obstruction. Can Med Assoc J 1983; 128: 555–558.

    1. Jaber S, Carlucci A, Boussarsar M: Helium-oxygen in the postextubation period decreases inspiratory effort. Am J Respir Crit Care Med 2001; 164: 633–637.

    1. Rodeberg DA, Easter AJ, Washam MA, Housinger TA, Greenhalgh DG, Warden GD: Use of a helium-oxygen mixture in the treatment of postextubation stridor in pediatric patients with burns. J Burn Care Rehabil 1995; 16: 476–480.

    1. Kemper KJ, Ritz RH, Benson MS, Bishop MS: Helium-oxygen mixture in the treatment of postextubation stridor in pediatric trauma patients. Crit Care Med 1991; 19: 356–359.

    1. Boorstein JM, Boorstein SM, Humphries GN, Johnston CC: Using helium-oxygen mixtures in the emergency management of acute upper airway obstruction. Ann Emerg Med 1989; 18: 688–690.

    1. Peng Z, Chen W, Wang L, Ye Z, Gao S, Sun X, Guo Z: Inhalation of hydrogen gas ameliorates glyoxylate-induced calcium oxalate deposition and renal oxidative stress in mice. Int J Clin Exp Pathol 2015; 8: 2680–2689.

    1. Cui J, Chen X, Zhai X, Shi D, Zhang R, Zhi X, Li X, Gu Z, Cao L, Weng W, Zhang J, Wang L, Sun X, Ji F, Hou J, Su J: Inhalation of water electrolysis-derived hydrogen ameliorates cerebral ischemia-reperfusion injury in rats – a possible new hydrogen resource for clinical use. Neuroscience 2016; 335: 232–241.

    1. Li H, Chen O, Ye Z, Zhang R, Hu H, Zhang N, Huang J, Liu W, Sun X: Inhalation of high concentrations of hydrogen ameliorates liver ischemia/reperfusion injury through A2A receptor mediated PI3K-Akt pathway. Biochem Pharmacol 2017; 130: 83–92.

    1. Liu X, Ma C, Wang X, Wang W, Li Z, Wang X, Wang P, Sun W, Xue B: Hydrogen coadministration slows the development of COPD-like lung disease in a cigarette smoke-induced rat model. Int J Chron Obstruct Pulmon Dis 2017; 12: 1309–1324.

    1. Gong ZJ, Guan JT, Ren XZ, Meng DY, Zhang HR, Wang BL, Yan XX: [Protective effect of hydrogen on the lung of sanitation workers exposed to haze]. Zhonghua Jie He He Hu Xi Za Zhi 2016; 39: 916–923.

    1. Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Chen R, Decramer M, Fabbri LM, Frith P, Halpin DM, Lopez Varela MV, Nishimura M, Roche N, Rodriguez-Roisin R, Sin DD, Singh D, Stockley R, Vestbo J, Wedzicha JA, Agusti A: Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary. Am J Respir Crit Care Med 2017; 195: 557–582.

    1. Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG: CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ 2010; 340:c869.

    1. Freitag L, Ernst A, Unger M, Kovitz K, Marquette CH: A proposed classification system of central airway stenosis. Eur Respir J 2007; 30: 7–12.

    1. Wang R, Wu J, Chen Z, Xia F, Sun Q, Liu L: Postconditioning with inhaled hydrogen promotes survival of retinal ganglion cells in a rat model of retinal ischemia/reperfusion injury. Brain Res 2016; 1632: 82–90.

    1. Xiao SC, He BT, Steier J, Moxham J, Polkey MI, Luo YM: Neural respiratory drive and arousal in patients with obstructive sleep apnea hypopnea. Sleep 2015; 38: 941–949.

    1. Luo YM, Moxham J, Polkey MI: Diaphragm electromyography using an oesophageal catheter: current concepts. Clin Sci (Lond) 2008; 115: 233–244.

    1. Guan WJ, Yuan JJ, Gao YH, Li HM, Zheng JP, Chen RC, Zhong NS: Impulse oscillometry and spirometry small-airway parameters in mild to moderate bronchiectasis. Respir Care 2016; 61: 1513–1522.

    1. Bickel S, Popler J, Lesnick B, Eid N: Impulse oscillometry: interpretation and practical applications. Chest 2014; 146: 841–847.

    1. Hess DR, Fink JB, Venkataraman ST, Kim IK, Myers TR, Tano BD: The history and physics of heliox. Respir Care 2006; 51: 608–612.

    1. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med 2002; 166: 518–624.

    1. Diehl JL, Peigne V, Guerot E, Faisy C, Lecourt L, Mercat A: Helium in the adult critical care setting. Ann Intensive Care 2011; 1: 24.

    1. Liistro G, Veriter C, Stanescu D: Influence of gas density on simulated snoring. Eur Respir J 1999; 13: 679–681.

    1. Glauser SC, Glauser EM, Rusy BF: Influence of gas density and viscosity on the work of breathing. Arch Environ Health 1969; 19: 654–660.

    1. Houck JR, Keamy MF 3rd, McDonough JM: Effect of helium concentration on experimental upper airway obstruction. Ann Otol Rhinol Laryngol 1990; 99: 556–561.

    1. Liu ZD, Qiu ZH, Tan KX, Xiao SC, Liu MF, Luo YM: [Assessment of neural respiratory drive in humans]. Zhonghua Jie He He Hu Xi Za Zhi 2013; 36: 493–496.

    1. Xiao SC, Lu YR, Guo HX, Qiu ZH, Luo YM: Effect of expiratory load on neural inspiratory drive. Chin Med J (Engl) 2012; 125: 3629–3634.

    1. Tang J, Lu YR, Luo YM: [Respiratory effort assessed by surface diaphragm EMG in patients with sleep apnea]. Zhonghua Jie He He Hu Xi Za Zhi 2009; 32: 732–735.

    1. Curtis JL, Mahlmeister M, Fink JB, Lampe G, Matthay MA, Stulbarg MS: Helium-oxygen gas therapy. Use and availability for the emergency treatment of inoperable airway obstruction. Chest 1986; 90: 455–457.

    1. Mizrahi S, Yaari Y, Lugassy G, Cotev S: Major airway obstruction relieved by helium/oxygen breathing. Crit Care Med 1986; 14: 986–987.

    1. Duncan PG: Efficacy of helium – oxygen mixtures in the management of severe viral and post-intubation croup. Can Anaesth Soc J 1979; 26: 206–212.

    1. Fleming MD, Weigelt JA, Brewer V, McIntire D: Effect of helium and oxygen on airflow in a narrowed airway. Arch Surg 1992; 127: 956–959; discussion 959–960.

    1. Maggiore SM, Richard JC, Abroug F, Diehl JL, Antonelli M, Sauder P, Mancebo J, Ferrer M, Lellouche F, Lecourt L, Beduneau G, Brochard L: A multicenter, randomized trial of noninvasive ventilation with helium-oxygen mixture in exacerbations of chronic obstructive lung disease. Crit Care Med 2010; 38: 145–151.

    1. Haussermann S, Schulze A, Katz IM, Martin AR, Herpich C, Hunger T, Texereau J: Effects of a helium/oxygen mixture on individuals’ lung function and metabolic cost during submaximal exercise for participants with obstructive lung diseases. Int J Chron Obstruct Pulmon Dis 2015; 10: 1987–1997.

    1. Komarow HD, Myles IA, Uzzaman A, Metcalfe DD: Impulse oscillometry in the evaluation of diseases of the airways in children. Ann Allergy Asthma Immunol 2011; 106: 191–199.

    1. Oostveen E, MacLeod D, Lorino H, Farre R, Hantos Z, Desager K, Marchal F; Measurements ERSTFoRI: The forced oscillation technique in clinical practice: methodology, recommendations and future developments. Eur Respir J 2003; 22: 1026–1041.

    1. Vicencio AG, Bent J, Tsirilakis K, Nandalike K, Veler H, Parikh S: Management of severe tracheal stenosis using flexible bronchoscopy and impulse oscillometry. J Bronchology Interv Pulmonol 2010; 17: 162–164.

    1. Handa H, Huang J, Murgu SD, Mineshita M, Kurimoto N, Colt HG, Miyazawa T: Assessment of central airway obstruction using impulse oscillometry before and after interventional bronchoscopy. Respir Care 2014; 59: 231–240.

  1. Verbanck S, de Keukeleire T, Schuermans D, Meysman M, Vincken W, Thompson B: Detecting upper airway obstruction in patients with tracheal stenosis. J Appl Physiol (1985) 2010; 109: 47–52.
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