Can I Use Cannulaide® with Vapotherm®?
Cannulaide® is a transparent adhesive designed to relieve irritation of the nares in neonates who are placed on nasal CPAP. The product creates an air seal to support the pressure mechanism of CPAP while ensuring that the cannula prongs do not fully occlude the neonate’s nares and thereby don’t lead to a potential Hospital Acquired Pressure Injury (HAPI). While Vapotherm’s high velocity therapy is a viable alternative to Non-Invasive Positive Pressure Ventilation (NIPPV), Vapotherm’s mechanism of action is not pressure-based[1,2] and therefore we strongly recommend against the use of cannulaide with Vapotherm cannulas.
Air egress is a crucial component of the ventilatory effect that high velocity therapy achieves which is why there must be no air seal on Vapotherm’s cannulas.[3,4,5] Vapotherm manufactures five different cannula sizes for the neonate population (and an additional three for the adult and pediatric population) in order to ensure that clinicians can select a cannula size that does not occlude more than 50% of the nares.
While a small amount of positive end-expiratory pressure (PEEP) is generated on high velocity therapy, the space around Vapotherm prongs is needed for efficacious flushing of the nasopharyngeal dead space. High velocity therapy and its mechanism of action has been found to have similar clinical efficacy to NIPPV in the neonatal and adult populations for management of respiratory distress. Neither Cannulaide, nor any other air seal, was used in these studies.[1,2]
Learn more about neonatal HFNC best practices
REFERENCES
[1] Kugleman A, Riskin A, Said W, Shoris I, Mor F, Bader D. A randomized pilot study comparing heated humidified high-flow nasal cannulae with NIPPV for RDS. Pediatric Pulmonology, 2014 Mar 12; 50(6) 576-83. (Clinical Trial, Prospective, Randomized, Single Site, n=76)
[2] Doshi, Pratik et al. High-Velocity Nasal Insufflation in the Treatment of Respiratory Failure: A Randomized Clinical Trial. Annals of Emergency Medicine, 2018. Published online ahead of print.
[3] Frizzola M, Miller T, Rodriguez ME, Dysart K. High-flow nasal cannula: Impact on oxygenation and ventilation in an acute lung injury model. Ped Pulmonology. 2011 Jan; 46(1): 67-74. (Mechanistic: animal, Prospective, Repeated Measures, Single Site, n=13).
[4] Dysart K, Miller T, Wolfson M, Shaffer T. Research in high flow therapy: Mechanisms of action. Respiratory Medicine. 2009; 103: 1400-05. (Review)
[5] Miller T, Saberi B, Saberi S. Computational fluid dynamics modeling of extrathoracic airway flush: evaluation of high flow nasal cannula design elements. J of Pulmonary & Respiratory Med. 2016; 6(5). (Bench, Prospective, Not Randomized, Single Site)
DISCLAIMER
This webpage contains links to third party abstracts and/or publications. With respect to those materials, please note that Vapotherm’s Hi-VNI® technology is a tool for treating the signs and symptoms of respiratory distress in patients for whom prescribers desire to add heat and moisture to breathing gases. The linked materials may describe certain outcomes in relation to the use of Vapotherm’s Hi-VNI Technology, but individual results may vary. Practitioners should refer to the full indications for use and operating instructions of any products referenced herein before prescribing them.