January 29, 2018
The results of the prospective, multi-center randomized controlled trial were published by Doshi and colleagues in January 2018 in Annals of Emergency Medicine titled High-Velocity Nasal Insufflation in the Treatment of Respiratory Failure: A Randomized Clinical Trial. The trial found no difference between the therapies in intubation rates or treatment failure rates. The authors conclude that Vapotherm High Velocity Nasal Insufflation is noninferior to NIPPV for the treatment of adult patients experiencing undifferentiated respiratory failure in the Emergency Department.
At the time of publishing, Vapotherm Hi-VNI® Technology is the only high flow nasal cannula (HFNC) approach that has been shown to be as clinically effective as NIPPV as a tool for treating the signs and symptoms of adult patients experiencing undifferentiated respiratory distress. These data suggest Vapotherm Hi-VNI Technology is a suitable alternative to an NIPPV approach as a non-invasive ventilation strategy.
Dyspnea and respiratory failure are among the top 5 reasons for Emergency Department visits. Clinicians have historically utilized non-invasive positive pressure ventilation (NIPPV) as primary non-invasive therapy for adult patients in respiratory distress. Other tools for the management of these patients include oxygen therapy, high flow nasal cannula (HFNC), and mechanical ventilation with endotracheal intubation.
While HFNC usage has increased in emergency departments and intensive care units, previous clinical studies have reported utility of HFNC in the management of hypoxic patients, who are specifically not hypercapnic. This important clinical trial is a capstone to a body of research led by Vapotherm for refining high flow nasal cannula to have an optimized ventilatory effect, thus enabling the technology to be used in patients requiring support with CO2 ventilation. High Velocity Nasal Insufflation utilizes a small-bore cannula and circuit that facilitates more efficient dead space washout with resultant improvement in ventilation efficiency.
1. Weiss AJ, Wier LM, Stocks C, Blanchard J. Overview of Emergency Department Visits in the United States, 2011. Agency for Healthcare Research and Quality; 2014.
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. Hernandez G, Vaquero C, Gonzalez P, et al. Effect of Postextubation High-Flow Nasal Cannula vs Conventional Oxygen Therapy on Reintubation in Low-Risk Patients: A Randomized Clinical Trial. JAMA. 2016;315(13):1354-1361.
4. Frat JP, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. The New England journal of medicine. 2015;372(23):2185-2196.