[Efficiency and safety of the integrated use of medical gases thermal heliox, nitric oxide and molecular hydrogen in patients with exacerbation of chronic obstructive pulmonary disease complicated by hypoxemic, hypercapnic respiratory failure and secondary pulmonary arterial hypertension in the post-COVID period].

Abstract

This randomized, parallel-group, controlled study enrolled 100 patients (52 male, 48 female) who had experienced SARS-CoV-2 pneumonia and subsequently developed COPD exacerbation (GOLD evidence levels C and D) complicated by hypoxemic-hypercapnic respiratory failure and secondary pulmonary arterial hypertension. Participants were allocated to five groups receiving various combinations of thermal heliox (t-He/O₂), nitric oxide (NO), and molecular hydrogen (H₂) alongside non-invasive ventilation and standard pharmacotherapy. The group receiving all three gases sequentially demonstrated superior outcomes across multiple parameters—including pulmonary gas exchange, acid-base balance, hemodynamics, shunt fraction, and exercise tolerance—compared with groups receiving individual gases or standard care alone. Reductions in hypoxemia and hypercapnia, improvements in vascular endothelial function, and restoration of metabolic indices were observed. No safety concerns were identified with the combined gas regimen.

Mechanism

Sequential administration of H₂, NO, and thermal heliox is proposed to normalize pulmonary gas exchange, increase oxygen delivery to tissues, reduce intrapulmonary shunt fraction, improve vascular endothelial function, and restore metabolic homeostasis through complementary pathophysiological mechanisms.