New Randomized Controlled Trial Recommends Vapotherm High Velocity Therapy as Front-Line Tool for Patients Admitted to ICU with Severe Bronchiolitis

Vapotherm’s high velocity therapy is a tool for treating respiratory distress in patients for whom prescribers desire to add heat and moisture to breathing gases. This webpage contains links to third party abstracts and/or publications that describe certain outcomes in relation to the use of Vapotherm’s high velocity therapy, 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.

In June 2018, Ergul and colleagues published the results of a single-center, randomized controlled trial in the European Journal of Pediatrics titled “Using a high-flow nasal cannula provides superior results to OxyMask delivery in moderate to severe bronchiolitis: a randomized controlled study.” The trial evenly randomized 60 patients (age 1-24 months) admitted to the PICU with moderate or severe bronchiolitis into either a High Flow Nasal Cannula (HFNC) group or a diffuser mask group.^[1] It is important to note that the study used Vapotherm high velocity therapy exclusively for the HFNC arm. Although high velocity therapy has been traditionally regarded as a type of HFNC, more recent evidence, as well as FDA labeling, suggest that it is Mask-Free NIV^™ for spontaneously breathing patients.

The results showed no failures in the high velocity therapy group and seven treatment failures in the oxygen diffuser group (P = 0.011), with the probability of survival being significantly higher for the HFNC group (P = 0.009). Children who failed in the oxygen diffuser group were put on high velocity therapy. It is worth noting that only one of the patients included in the study had moderate bronchiolitis, while the rest had severe. No patient required noninvasive mechanical ventilation. The study’s limitations were the small sample size pooled from a single center.

The study’s secondary outcomes examined time to wean off oxygen treatment, length of stay (LOS) in the PICU, and length of hospital stay.^[1] In all cases the high velocity therapy protocol group had better outcomes than the diffuser mask group, with weaning time being 56h vs. 96h, PICU LOS being 3 vs 4 days, and hospital LOS being 4 vs 5 days respectively (P < 0.001 in call cases). The results also showed that the high velocity therapy group experienced a faster decrease of heart and respiration rate. There was no significant difference in pCO₂ level or lactate reduction between the two groups.

The authors conclude that given the results, HFNC/high velocity therapy should be the front-line tool for oxygen therapy in patients admitted to the ICU with severe bronchiolitis.

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