High Velocity Nasal Insufflation (HVNI) is Mask-Free Noninvasive Ventilation pioneered by Vapotherm® for the treatment of undifferentiated respiratory distress in spontaneously breathing patients. Here are a few benefits that hospitals, clinicians, and their patients may experience with this breakthrough at the frontlines of respiratory care.
1. Clinical Efficacy of NiPPV, but Without the Mask
Figure 1: Adapted from Doshi et al, HVNI in the Treatment of Respiratory Failure, Ann of Emerg Med, 2017; 1:11.
In a multi-center, randomized, controlled trial published in 2018 in the Annals of Emergency Medicine, Doshi and colleagues conclude that HVNI is a viable alternative to non-invasive positive pressure ventilation (NiPPV).11. Doshi, Pratik et al. High-Velocity Nasal Insufflation in the Treatment of Respiratory Failure: A Randomized Clinical Trial. Annals of Emergency Medicine, 2018. https://www.ncbi.nlm.nih.gov/pubmed/29310868Read Full Text The trial enrolled adults presenting in the Emergency Department in undifferentiated respiratory distress, and showed statistically equivalent outcomes in avoiding intubations, (Figure 1). This study was conducted on Vapotherm’s Hi-VNI® Technology, which as of the time of this writing is the only mask-free system cleared by the Food and Drug Administration (FDA) for the treatment of undifferentiated respiratory distress in spontaneously breathing patients.
2. Caring for Patients who Can’t or Won’t Wear a Mask
Patients with mask-intolerance due to anxiety, nausea or facial hair present a familiar problem to clinicians prescribing NiPPV to relieve respiratory distress. Studies show that more than 30% of NIV failure is attributed to patients who are mask-intolerant.22. Carron M. et al. Complications of non-invasive ventilation techniques: a comprehensive qualitative review of randomized trials. British Journal of Anaesthesia. 110(6):896-914. (2013) https://www.ncbi.nlm.nih.gov/pubmed/23562934Read Full Text Techniques for reducing anxiety such as coaching, or sitting with patients, may increase intensity of care. Additionally, patients failing NiPPV and having to be intubated results in both increased risks and costs. Hi-VNI Technology offers a viable, mask-free alternative to NiPPV, particularly for the mask-intolerant patient.
Figure 2 illustrates just such a case of an NiPPV intolerant patient placed on Hi-VNI Technology. You can read the full case study here.
Figure 2: Case Study of NiPPV intolerant patient successfully stabilized with Hi-VNI Technology.
3. Greater Patient Comfort via a Simple Mask-Free Interface
HVNI delivered with Hi-VNI Technology is a gentle, easy to tolerate respiratory treatment that allows patients to eat, drink, and take oral medications while receiving respiratory support. The mask-free interface enables easy communication with clinicians and family members, all of which may lead to greater compliance with the treatment. The lack of a tight-fitting mask may also lead to fewer hospital acquired pressure injuries.
4. Ability to Transfer and Ambulate Patients Without Compromising Respiratory Support
The Vapotherm Transfer Unit (VTU) allows for in-hospital transfers as well as easy patient ambulation while the patient still received full respiratory support.
In the ED the ability to move patients on therapy can greatly improve workflow. For one hospital’s success story using Hi-VNI Technology with the VTU to streamline workflow streamlining thanks to read about Norman Regional Hospital—one of the five busiest Emergency Departments in Oklahoma.
5. An Easy-to-Use De-Escalation Therapy
You want to know fast if a respiratory support modality will work for a particular patient. The faster you stabilize the better. With Hi-VNI Technology you can safely start patients at high flow rates to rescue fast, and then titrate down for comfort and clinical effect. Unlike the tightly strapped on mask of NiPPV, the non-occlusive Hi-VNI cannula creates an open system interface with the patient, and as a result, there is little risk of generating inadvertent excess pressure. Instead of starting low and turning therapy up for effect, you can safely start high and turn down on response.
Figure 3 illustrates the degree to which clinicians in Doshi and colleagues’ study11. Doshi, Pratik et al. High-Velocity Nasal Insufflation in the Treatment of Respiratory Failure: A Randomized Clinical Trial. Annals of Emergency Medicine, 2018. https://www.ncbi.nlm.nih.gov/pubmed/29310868Read Full Text rated Hi-VNI Technology patient response compared to NiPPV.
Figure 3: Used from Doshi et al, HVNI in the Treatment of Respiratory Failure, Ann of Emerg Med, 2017; 1:11.