Imagine the Ventilatory Support of NiPPV with the Comfort of Humidified High Flow

Clinicians admitting patients in respiratory distress traditionally have three categories of tools to relieve symptoms. There is oxygen therapy for low severity patients, non-invasive positive pressure ventilation (NiPPV) for moderate distress, and then mechanical ventilation for severe cases of respiratory distress. Thanks to high velocity therapy, clinicians now have a new tool to treat a broad range of patients experiencing undifferentiated respiratory distress.

High velocity therapy offers a solution for the drawbacks of commodity high flow oxygen systems and NiPPV systems.

Some of the advantages of tools like commodity high flow oxygen systems are that they offer humidified gases and tend to be more comfortable for patients than mask-based therapies. On the other hand, mask- and pressure-based therapies, like NiPPV, have been shown to be effective at treating hypercapnic patients in addition to relieving hypoxia. Therefore, NiPPV is often a go-to therapy for patients presenting in the Emergency Department with undifferentiated respiratory distress when clinicians want to quickly stabilize a patient without immediately knowing whether they are hypercapnic, hypoxemic, or a combination of the two.

However, patients may have difficulty tolerating mask-based interfaces, and about a third of NiPPV failure is attributed to mask-intolerance.[1] These patients may be able to better tolerate the cannula interface of commodity high flow oxygen products. However, studies using those products generally don’t include patients with hypercapnia.[2,3] This leaves clinicians without a simple solution for the mask-intolerant patient in undifferentiated respiratory distress.

High velocity therapy is one tool that combines the appealing benefits of both of these systems: a mask-free, comfortable interface and the clinical efficacy of NiPPV.

High velocity therapy has been clinically proven to be a viable alternative to NiPPV in the treatment of undifferentiated respiratory distress in adults, including hypercapnia.[4] When it comes to the neonatal population, high velocity therapy has also been demonstrated to have comparable outcomes to NCPAP and bi-level PAP.[5] Yet, it has an easy-to-tolerate, mask-free interface and delivers optimally humidified breathing gases.[6]

Although high velocity therapy operates in part based on L/min selection, it is not a commodity high flow oxygen system, and although it can offer ventilatory support, its primary mechanism of action is velocity not pressure. Instead, high velocity therapy is mask-free NIV for spontaneously breathing patients.

Learn more about Vapotherm High Velocity Therapy

[1] 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)
[2] Frat, Jean-Pierre, Rémi Coudroy, Nicolas Marjanovic, and Arnaud W. Thille. “High-flow nasal oxygen therapy and noninvasive ventilation in the management of acute hypoxemic respiratory failure.” Ann Transl Med. 2017 Jul; 5(14): 297.
[3] Hernández, Gonzalo, Concepción Vaquero, Laura Colinas, et al. “Effect of Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High-Risk Patients A Randomized Clinical Trial.” JAMA. 2016;316(15):1565-1574. doi:10.1001/jama.2016.14194
[4] Doshi, Pratik et al. High-Velocity Nasal Insufflation in the Treatment of Respiratory Failure: A Randomized Clinical Trial. Annals of Emergency Medicine, 2018.
[5] 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.
[6] Waugh J, Granger W. An evaluation of 2 new devices for nasal high-flow gas therapy. Respiratory Care. 2004 Aug; 49(8): 902-906.