How Your Precision Flow® Systems Could Help Streamline Your Emergency Department Workflow

Given the flu season is in full swing you are likely seeing patients coming in with respiratory distress that stems from exacerbations of underlying conditions, like COPD.1 Chances are you are using noninvasive positive pressure ventilation (NiPPV) to treat some of these patients. If this sounds like your practice, you’re not alone. But some of the steps in this workflow can be time-consuming—such as coaching patients for compliance or carefully increasing NiPPV pressure to clinical effectiveness.

If you are already using a Precision Flow system, you are familiar with its advantages—the easy interface fitting, minimal patient coaching, the user-friendly, fully integrated device are among the features our customers know and like. What some practitioners may not know is that in addition to treating hypoxemia, this technology can also treat hypercapnia. Increasingly clinicians are becoming aware that Vapotherm® Precision Flow systems with high velocity therapy are proven to be clinically as effective as NiPPV while offering the benefits of a mask-free cannula interface.

This new awareness of a familiar modality is leading to some changes in clinical practice. Here is an example of Dr. Rebecca Reamy, Medical Director of the Pediatrics Emergency Department and Chief of Pediatrics at Piedmont Columbus Regional who frankly tells her story of her clinical experience and learning how to use this Mask-Free NIV™ for spontaneously breathing patients.2,3

“When I was introduced to this and saw how effective it was, I still didn’t think of it every time, but my Respiratory Therapist would say ‘Hey, I think this patient would benefit from Hi-VNI Technology.’ ‘Oh, that’s a great idea!’ And I would put the patient on and they got better.”—Dr. Reamy

Once clinicians learn that there is a mask-free alternative to NiPPV, the advantages become obvious:

– About a third of the time NiPPV fails due to patients’ mask intolerance.4 The Precision Flow cannula interface is comfortable, easy to tolerate and allows patients to eat, drink, and take oral medication.

– Vapotherm high velocity is a de-escalation therapy. While you have to start NiPPV settings low and slowly escalate them, with high velocity therapy, you can safely start patients at high flow rates to rescue fast, and then titrate down for comfort and clinical effect.

– Patients can comfortably communicate with you and their family members without therapy interruption. Without an interface that covers their mouth, they can be easier to understand.

If your hospital isn’t using high velocity therapy to treat hypercapnia, you may not be getting the most out of your devices. If you’re not sure where to start, download this sample adult Emergency Department protocol. It is based off the randomized controlled trial protocol that showed high velocity therapy to be as effective as gold standard NiPPV and can serve as a good starting point to help you use your tool kit to its fullest extent.2


1. Wilkinson TMA, Aris E, Bourne S et al., A prospective observational cohort study of the seasonal dynamics of airway pathogens in the aetiology of exacerbations in COPD. Thorax. 2017;72(10):919-927.
2. Doshi, Pratik et al. High-Velocity Nasal Insufflation in the Treatment of Respiratory Failure: A Randomized Clinical Trial. Annals of Emergency Medicine, 2018.
3. Lavizarri A, Colnaghi M, Ciuffini F, Veneroni C, Musumeci S, Cortinovis I, Mosca F. “Heated, humidified high-flow nasal cannula vs nasal continuous positive airway pressure for respiratory distress syndrome of prematurity – a randomized clinical noninferiority trial.” JAMA Pediatr. 2016 Aug 8.
4. 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)