Clinical experience with the use of oxygen-helium mixture in rehabilitation and outpatient treatment of patients with acute community-acquired pneumonia with ischemic heart disease

Background. Community-acquired pneumonia in elderly patients with concomitant coronary artery disease is characterized by high risk of cardiovascular complications and mortality due to systemic inflammatory response, endothelial dysfunction, and hypoxemia. Standard therapeutic protocols demonstrate insufficient efficacy, necessitating the search for innovative rehabilitation strategies. Objective. To evaluate the clinical efficacy and safety of heated helium-oxygen mixture (thermoheliox) inhalations in the complex therapy and rehabilitation of patients with moderate-to-severe community-acquired pneumonia with underlying coronary artery disease. Materials and methods. An open-label randomized clinical trial included 320 patients (aged 40-80 years) with CT-verified community-acquired pneumonia and concomitant CAD, discharged from hospital within 5 days. Patients were divided into two groups: the main group (n=160) received standard therapy supplemented with a 10- day course of thermoheliox inhalations (70% helium, 30% oxygen, temperature 50-80°C) in cyclic regimen; the control group (n=160) received standard treatment only. Clinical, laboratory (CRP, leukocytes, ESR), instrumental (spirometry, echocardiography, chest CT, capnometry, pulse oximetry), and psychometric parameters (TOBOL test, 6-minute walk test) were assessed. Results. The thermoheliox therapy group demonstrated significant acceleration of clinical symptom resolution, with CRP normalization on day 10 in 90% vs 75% in controls (p<0.05). The incidence of pulmonary complications (bronchiolitis, atelectasis, emphysematous bullae) at 3 months was 12% vs 37% in the control group. Gas exchange parameters improved faster: PaCO₂ normalization was achieved in 85% vs 69%, SpO₂ ≥95% on day 5 in 100% vs 93-94% in controls. Exercise tolerance by 6-minute walk test increased by 8.1% vs 1.2%. Central hemodynamic parameters showed reduction in total peripheral resistance from 1480±150 to 980±56 dyn/sec/cm⁻⁵ and increase in cardiac output from 3.5±0.6 to 5.3±1.0 L/min. Psychological testing revealed an increase in patients with harmonious attitude toward disease from 52% to 82% vs 54% to 64% in controls. Conclusions. The use of heated heliumoxygen mixture in rehabilitation of patients with community-acquired pneumonia with underlying CAD demonstrates pronounced clinical effect, reduces pulmonary complications by 66%, improves central hemodynamic parameters by 42%, and shows high safety profile. The method is recommended for inclusion in comprehensive treatment programs for this patient category.