Medical gas therapy is a treatment involving the administration of various gases. It has been used in medicine since the use of

oxygen therapy Oxygen therapy, also known as supplemental oxygen, is the use of oxygen as medical treatment. Acute indications for therapy include hypoxemia (low blood oxygen levels), carbon monoxide toxicity and cluster headache. It may also be prophylactica ...

. Many other gases, collectively known as

factitious airs Factitious airs was a term used for synthetic gases which emerged around 1670 when Robert Boyle coined the term upon isolating what is now understood to be hydrogen. ''Factitious'' means "artificial, not natural", so the term means "man-made gases ...

, were explored for medicinal value in the late eighteenth century.

Nitric oxide

Nitric oxide Nitric oxide (nitrogen oxide or nitrogen monoxide) is a colorless gas with the formula . It is one of the principal oxides of nitrogen. Nitric oxide is a free radical: it has an unpaired electron, which is sometimes denoted by a dot in its che ...

is a gas that is inhaled. It was initially described in 1987 as an "endothelial-derived relaxing factor" and has since been used to treat pulmonary disorders. It works by relaxing

smooth muscle Smooth muscle is an involuntary non-striated muscle, so-called because it has no sarcomeres and therefore no striations (''bands'' or ''stripes''). It is divided into two subgroups, single-unit and multiunit smooth muscle. Within single-unit mus ...

to widen (dilate)

blood vessels The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide away f ...

, especially in the lungs. Nitric oxide is used together with a

mechanical ventilator A ventilator is a piece of medical technology that provides mechanical ventilation by moving breathable air into and out of the lungs, to deliver breaths to a patient who is physically unable to breathe, or breathing insufficiently. Ventilators ...

to treat

respiratory failure Respiratory failure results from inadequate gas exchange by the respiratory system, meaning that the arterial oxygen, carbon dioxide, or both cannot be kept at normal levels. A drop in the oxygen carried in the blood is known as hypoxemia; a rise ...

premature infants Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between 2 ...

Helium and oxygen

In medicine,

heliox Heliox is a breathing gas mixture of helium (He) and oxygen (O2). It is used as a medical treatment for patients with difficulty breathing because mixture generates less resistance than atmospheric air when passing through the airways of the lung ...

generally refers to a mixture of 21% O₂ (the same as

air The atmosphere of Earth is the layer of gases, known collectively as air, retained by Earth's gravity that surrounds the planet and forms its planetary atmosphere. The atmosphere of Earth protects life on Earth by creating pressure allowing f ...

) and 79% He, although other combinations are available. Heliox generates less airway resistance than air and thereby requires less mechanical energy to ventilate the lungs. "Work of Breathing" (WOB) is reduced. It does this by two mechanisms: # increased tendency to

laminar flow In fluid dynamics, laminar flow is characterized by fluid particles following smooth paths in layers, with each layer moving smoothly past the adjacent layers with little or no mixing. At low velocities, the fluid tends to flow without lateral mi ...

; # reduced resistance in

turbulent flow In fluid dynamics, turbulence or turbulent flow is fluid motion characterized by chaotic changes in pressure and flow velocity. It is in contrast to a laminar flow, which occurs when a fluid flows in parallel layers, with no disruption between ...

. Heliox has a similar

viscosity The viscosity of a fluid is a measure of its resistance to deformation at a given rate. For liquids, it corresponds to the informal concept of "thickness": for example, syrup has a higher viscosity than water. Viscosity quantifies the inte ...

to air but a significantly lower

density Density (volumetric mass density or specific mass) is the substance's mass per unit of volume. The symbol most often used for density is ''ρ'' (the lower case Greek letter rho), although the Latin letter ''D'' can also be used. Mathematical ...

(0.5 g/L versus 1.2 5g/L at

STP STP may refer to: Places * São Tomé and Príncipe (ISO 3166-1 alpha-3 code, IOC country code, and FIFA country code STP) * St Pancras railway station, London St Pancras (Domestic) railway station (National Rail code STP) * St. Paul Downtown Air ...

). Flow of gas through the

airway The respiratory tract is the subdivision of the respiratory system involved with the process of respiration in mammals. The respiratory tract is lined with respiratory epithelium as respiratory mucosa. Air is breathed in through the nose to th ...

s comprises

, transitional flow and

. The tendency for each type of flow is described by the

Reynolds number In fluid mechanics, the Reynolds number () is a dimensionless quantity that helps predict fluid flow patterns in different situations by measuring the ratio between inertial and viscous forces. At low Reynolds numbers, flows tend to be domi ...

Heliox Heliox is a breathing gas mixture of helium (He) and oxygen (O2). It is used as a medical treatment for patients with difficulty breathing because mixture generates less resistance than atmospheric air when passing through the airways of the lung ...

's low density produces a lower

and hence higher probability of laminar flow for any given airway.

Laminar flow In fluid dynamics, laminar flow is characterized by fluid particles following smooth paths in layers, with each layer moving smoothly past the adjacent layers with little or no mixing. At low velocities, the fluid tends to flow without lateral mi ...

tends to generate less resistance than turbulent flow. In the small airways where flow is laminar, resistance is proportional to gas

and is not related to

and so

has little effect. The

Hagen–Poiseuille equation In nonideal fluid dynamics, the Hagen–Poiseuille equation, also known as the Hagen–Poiseuille law, Poiseuille law or Poiseuille equation, is a physical law that gives the pressure drop in an incompressible and Newtonian fluid in laminar flow ...

describes laminar resistance. In the large airways where flow is turbulent, resistance is proportional to density, so

has a significant effect. Heliox has been used medically since the early 1930s. It was the mainstay of treatment in acute

asthma Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, cou ...

before the advent of

bronchodilators A bronchodilator or broncholytic (although the latter occasionally includes secretory inhibition as well) is a substance that dilates the bronchi and bronchioles, decreasing resistance in the respiratory airway and increasing airflow to the lungs ...

. Currently, heliox is mainly used in conditions of large airway narrowing (upper airway obstruction from tumors or foreign bodies and

vocal cord dysfunction Vocal cord dysfunction (VCD) is a pathology affecting the vocal folds (commonly referred to as the vocal cords) characterized by full or partial vocal fold closure causing difficulty and distress during respiration, especially during inhalation. ...

). There is also some use of heliox in conditions of the medium airways (

croup Croup, also known as laryngotracheobronchitis, is a type of respiratory infection that is usually caused by a virus. The infection leads to swelling inside the trachea, which interferes with normal breathing and produces the classic symptoms o ...

, asthma and

chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation. The main symptoms include shortness of breath and a cough, which may or may not produce ...

). Patients with these conditions may develop a range of symptoms including

dyspnea Shortness of breath (SOB), also medically known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathing, breathe well enough. The American Thoracic Society defines it as "a subjective experience of brea ...

(breathlessness),

hypoxemia Hypoxemia is an abnormally low level of oxygen in the blood. More specifically, it is oxygen deficiency in arterial blood. Hypoxemia has many causes, and often causes hypoxia as the blood is not supplying enough oxygen to the tissues of the body ...

(below-normal oxygen content in the arterial blood) and eventually a weakening of the respiratory muscles due to

exhaustion Fatigue describes a state of tiredness that does not resolve with rest or sleep. In general usage, fatigue is synonymous with extreme tiredness or exhaustion that normally follows prolonged physical or mental activity. When it does not resolve ...

, which can lead to

and require

intubation Intubation (sometimes entubation) is a medical procedure involving the insertion of a tube into the body. Patients are generally anesthetized beforehand. Examples include tracheal intubation, and the balloon tamponade with a Sengstaken-Blakemo ...

and

mechanical ventilation Mechanical ventilation, assisted ventilation or intermittent mandatory ventilation (IMV), is the medical term for using a machine called a ventilator to fully or partially provide artificial ventilation. Mechanical ventilation helps move air ...

. Heliox may reduce all these effects, making it easier for the patient to breathe. Heliox has also found utility in the weaning of patients off mechanical ventilation, and in the nebulization of inhalable drugs, particularly for the elderly. Research has also indicated advantages in using helium–oxygen mixtures in delivery of

anaesthesia Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), am ...

References

{{reflist Respiratory therapy Pulmonology Medical treatments Industrial gases