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Heliox, a mixture of helium and oxygen, was used by Barach in New York for the first time in the treatment of asthma and upper airway obstruction after its introduction to deep sea diving. Since then it has been used not only as a rescue medication in emergency situations for spontaneously breathing patients with airway obstruction but also as the driving gas for mechanical ventilators. The increasing interest in heliox is indicated by the rising number of publications in recent years. This chapter outlines the theoretical considerations, the application of heliox in non-intubated (e.g. with upper and lower airway obstruction) as well as in ventilated patients followed by a brief overview of potential risks and cost considerations. Future developments focus on ways to routinely apply heliox during mechanical ventilation, for example, as a commercially available add-on feature to conventional ventilators.
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