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

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 high velocity therapy is the only mask-free non-invasive ventilation for spontaneously breathing patients that has been shown to be as clinically effective as NIPPV as a tool for treating adult patients experiencing undifferentiated respiratory distress. These data suggest Vapotherm high velocity therapy 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 hypoxemic patients, who are specifically not hypercapnic. This important clinical trial is a capstone to a body of research led by Vapotherm for defining mask-free non-invasive ventilation, 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.

Watch the Roundtable discussion of high velocity therapy use beyond COVID. 

[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.