Inhalation Effect of Heated Helium-Oxygen Mixture and Nitric Oxide on Gas Exchange Parameters in Patients with Polytrauma and Pulmonary Contusion

The heated helium-oxygen mixture (t-He/O₂, heliox ) reduces resistance in the airways and improves ventilation in affected zones of the lungs. Inhaled nitric oxide (NO) is a selective pulmonary vasodilator that lowers pressure in the pulmonary artery and enhances the ventilation-perfusion matchig, which also contributes to the optimization of oxygenation.

The aim of the study is to assess the efficacy and safety of adding inhaled NO, t-He/O₂, and their combination to standard respiratory therapy in patients with polytrauma and pulmonary contusion.

Materials and Methods: We conducted an open prospective randomized study. 186 patients were divided into 4 groups: the NO group (n = 43), the t-He/O₂ group (n = 49), the t-He/O₂ + NO group (n = 48), and the control group (oxygen therapy, O₂, n = 46). The respiratory therapy course lasted 12 days. We assessed the dynamics of computed tomography (MSCT) signs of pulmonary contusion, as well as the arterial blood gas (ABG) parameters (PaO₂, PaCO₂, SaO₂, lactate, pH) on days 1, 4, 8, and 12.

Results. The most remarkable improvements were documented in the combination therapy group (t-He/O₂ + NO). By day 12, this group showed a statistically significant 69% reduction in the extent of lung injury on MSCT (p = 0.018), an increase in PaO₂ to 95.1 mm Hg (p < 0.001), a decrease in PaCO₂ to 35.8 mm Hg (p < 0.001), and a reduction in lactate to 1.38 mmol/L (p = 0.0025). The same parameters in the monotherapy groups NO or t-He/O₂ also markedly improved compared to the control group (O₂). No therapy-related adverse events were reported.

Conclusion. Employment of inhaled t-He/O₂ and NO, especially in combination, as a part of the total care plan of patients with polytrauma and pulmonary contusion, contributes to a significant improvement in gas exchange and regression of radiographic signs of lung tissue injury. Thereby, described method is recommended for early respiratory therapy in intensive care units.

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