Heliox should be available in every community hospital.

The June special issue of RESPIRATORY CARE features 6 symposium papers about the use of heliox gas. I agree with the guest editor, James Fink, that the issue is a “valuable resource for clinicians.”1 I write this letter because I think heliox has a special role in community hospitals; in fact, I believe that heliox should be available in every community hospital. In community hospitals, surgeons and anesthesiologists with advancedairwayskillsarenotalways readily available (eg, 10:00 pm Sunday on a holiday weekend). Patients who develop acute life-threatening upper-airway obstruction under such circumstances are in a terrible predicament. In addition, the respiratory therapist who will undoubtedly be summoned to such an emergency will be in the agonizing position of not having much to offer to the suffocating patient. Heliox is unique in that it can reduce airway resistance, work of breathing, and improve ventilation without changing the diameter of the airway. This makes heliox a life-saving bridge to definitive therapy (eg, tracheostomy) for the patient dying of severe upper-airway obstruction. Are there large randomized controlled trials to support my contention? No, and there never will be. There are simply not enough patients in this predicament to study, and even if there were, it would be unethical to deny patients a potentially life-saving therapy, which would be required to have a control group.2 We have used heliox at our community hospital for many years now, mostly for upper-airway obstruction, but occasionally for hypercapnic asthma exacerbations.3 We need to use it only a few times per year, but when we have needed it, heliox has proven to be a valuable tool to have available. Heliox is easy to administer, and directions for use can be kept with the tank if a department uses it only on rare occasions. In my mind, heliox in a community hospital should be viewed no differently than an automated defibrillator stationed in a public place, in that, even if you need it only once every 10 years to safe a life, it is still worth having around.