Preparing for the next severe respiratory illness outbreak

Setup for delivering heliox via high-flow nasal cannula

Setup for delivering heliox via high-flow nasal cannula. The heliox tank is on the right. (Image: Morgan, et al, Respiratory Care)

In August 2014, a mysterious, influenza-like, severe respiratory illness started causing an increase in emergency room visits across the Midwest. It started in Illinois, Missouri, and Colorado, but later spreading to 49 states. It had all the hallmarks of the seasonal flu too: coughing, runny nose, wheezing, fever, body aches and rashes. But it also caused scary symptoms of paralysis in some pediatric patients, leading doctors here at Comer Children’s Hospital to work with the CDC and other hospitals to identify and track its spread across the country.

The mystery virus turned out to be an enterovirus, a broad class of highly-contagious viruses related to polio that cause respiratory and neurologic illnesses. The 2014 outbreak was caused by a particular strain called enterovirus D68 (EV D68). That season, the University of Chicago Medicine had over 600 hospital admissions for patients in respiratory distress, many of them with EV D68, but many others with different enteroviruses, rhinoviruses, influenza and respiratory infections.

Critical care specialists at UChicago Medicine found that one of the most effective treatments for patients in respiratory distress was to use heliox, a mixture of helium and oxygen. Heliox is a much lighter gas than oxygen alone, and can penetrate inflamed, obstructed airways more effectively. In a recent case study, respiratory therapist Sherwin Morgan, RRT, RCP and his colleagues describe how they were able to use heliox with a 10-month-old baby with a coronavirus to avoid more drastic measures like intubation.

As flu season looms ahead in the coming months, it’s worth remembering that not every respiratory illness is the standard flu. Emergency rooms and clinics are on the front lines, and staff are always on the lookout for new diseases.  Morgan says he has already seen a spike in cases of patients in severe respiratory distress this year.

“There is major concern about a massive influx of patients this winter from influenza-like respiratory illness. Therefore, regional and global planning is very important,” he said. “It involves recognition, communications, containment, disinfection and support therapies, like high flow nasal cannula (HFNC) and heliox, to treat the air-flow obstruction breathing problems associated with these severe respiratory illnesses.”

About Matt Wood (491 Articles)
Matt Wood is a senior science writer for the University of Chicago Medicine and editor of the Science Life blog.
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