Vapotherm Shows Noninferiority to NIPPV for Undifferentiated Respiratory Distress in the Emergency Department

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.


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.
2018-02-22T22:06:48+00:00Jan 24|Vapotherm Blog|13 Comments


  1. Scott Fritschle, RRT, RCP February 22, 2018 at 7:01 am - Reply

    This study demonstrates that Vapotherm will likely become the therapy of choice over NIPPV in the ED. Not only does Vapotherm compete favorably with NIPPV, it is far more comfortable for patients.

  2. Terri March 2, 2018 at 1:38 pm - Reply

    Would like to know if there have been any studies done on premature babies and if so, what those results are as well as their outcomes

  3. Becky Henderson March 4, 2018 at 10:28 pm - Reply

    Is there a chance of this becoming available to patients in our homes?

    • Chris Walker March 5, 2018 at 12:27 pm - Reply

      Hi Becky, Vapotherm is currently cleared for use in the acute and post-acute hospital setting. We hope to help patients in the home setting in the future with a product specifically designed for this setting.

  4. Rachel March 5, 2018 at 1:06 am - Reply

    I had to watch both my parents suffer and then die while intubated. They struggled to come off of it. This is difficult for me to even write about but I wish there was a better alternative to intubation. What new research is being conducted on this topic? Thank you.

  5. Rachel March 5, 2018 at 1:07 am - Reply

    Is this new treatment an alternative to intubation?

    • Chris Walker March 5, 2018 at 12:26 pm - Reply

      Hi Rachel – Vapotherm has been shown to be a viable alternative to non-invasive positive pressure ventilation (NIPPV). This trial showed no difference in treatment failure rates or intubation rates between Vapotherm and NIPPV. Intubation may be required in some patients. In this trial, the intubation rate (high-velocity nasal insufflation=7%; noninvasive positive-pressure ventilation=13%; risk difference=–6%; 95% confidence interval –14% to 2%) met noninferiority criteria.

  6. LYNN Roots March 7, 2018 at 1:55 pm - Reply

    I have a dear friend and as a result of many hours I’d intubation during abdominal surgery has suffered long time effects of that same intubation for a few years now

    Also my husband was really traumatized by being intubated even though the ER at Eisenhower hospital handled him with the utmost care possible

    I’d love to think that there is a more gentle way to provide what these patients require

    It is so disturbing for all concerned !

    Thank you

  7. Rob Walker March 7, 2018 at 10:40 pm - Reply

    I’d be curious to see how this performs in the prehospital arena.

  8. Elizabeth April 23, 2018 at 10:09 pm - Reply

    Just to be clear, this is only for undifferentiated respiratory distress, correct? Because I’ve not seen many cases of hypoxia without hypercapnia or increased work of breathing aside from CO poisoning and PE. A high velocity humidified nasal system is usually ruled out early on, either due to patient history (i;e copd/chf) or because intubation is impending for a secondary reason. And if I’m wrong, does the vapotherm differ from similar systems in that I provides PEEP? There’s a lot of misconception that these units do in fact provide PEEP but the ones I have experience with thus far cannot make the claim because the value is not quantifiable and likely isn’t more than physiologic PEEP anyway. Seeing as how an end pressure affects oxygenation much more at fi02 above 60%, this would be a fantastic addition and could possibly be considered for more than just an increased shunt situation.

  9. Lorraine May 17, 2018 at 8:34 pm - Reply

    I have had many admissions over the last three years & evertime Iv had to experience the NIV – I am end stage of COPD. It is not very pleasant to wear & can quite panicky but it is a life saver! I was found unresponsive on Friday but I’m at home again with 1L LOT. To be honest Iv never heard of Vapotherm not even with my stays in hospital. Anything would be better then the NIV!

  10. Jodi June 20, 2018 at 2:45 pm - Reply

    I like the vapotherm I’ve used it In neonates an adults as well.

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