The First Major NIV Innovation in the Past 30 Years is Here! — And It May Be a Solution for Anxious Respiratory Distress Patients

Let’s face it, tightly strapped face masks are not exactly pleasant. While many respiratory distress patients tolerate mask and pressure-based therapies just fine, many also experience anxiety and claustrophobia. Yet the gold standard treatment for patients in undifferentiated respiratory distress is Noninvasive Positive Pressure Ventilation (NiPPV), even though about a third of all NiPPV failure is due to mask-intolerance.[1] It was about time for an alternative.

What is this new innovation?

Mask-Free NIV® for spontaneously breathing patients is a tool that provides ventilatory support to patients in undifferentiated respiratory distress, but as the name says, without a mask. Instead of a mask, patients are fitted with an easy-to-tolerate Precision Flow® Cannula and can talk, eat, drink, and take oral medication while on therapy. So, it’s easy to see that anxious patients who may have a hard time complying with the mask, or would require a lot of coaching from practitioners, could potentially receive treatment without the need for a mask.

The innovation here is Vapotherm high velocity therapy. Rather than using pressure as a primary mechanism of action, high velocity therapy has a velocity-based mechanism of action which rapidly flushes the upper airway dead space and fills it with a fresh gas reservoir, thereby facilitating alveolar ventilation.

Wait, isn’t it like this other tool we already have at our hospital?

Your hospital may already have Vapotherm high velocity therapy! If it doesn’t, you might be potentially thinking of commodity high flow oxygen products. Like high velocity therapy, these products employ a cannula interface and high liter flows, a reason high velocity therapy is sometimes confused for high flow. However, the differences are extensive and can best be summarized in two points:

  • The clinical outcomes of high velocity therapy are comparable to those of NiPPV.[2] High velocity therapy treats undifferentiated respiratory distress, including hypercapnia, hypoxemia, and dyspnea.
  • Vapotherm high velocity therapy is in the QAV product code category, as opposed to the BTT (or respiratory humidifier) product category where other commodity high flow oxygen products are classified. At the time of this writing the Precision Flow Hi-VNI system is the only product in this category.

Does it really work, even for hypercapnic patients?

Yes. A multi-center randomized controlled trial comparing high velocity therapy and NiPPV in the treatment of adult Emergency Department patients in undifferentiated respiratory distress, concluded that high velocity therapy had the comparable clinical outcomes to NiPPV.[2] Figure 1 depicts the statistical equivalence between high velocity therapy and NiPPV in regard to avoiding intubations. Figure 2 depicts their statistical equivalence in reducing CO2 in this study.

Intubation Rate (%)

Figure 1: Adapted from Doshi et al, HVNI in the Treatment of Respiratory Failure, Ann of Emerg Media, 2017;1:11.

Vapotherm High Velocity Therapy Efficiently Reduces CO2

Figure 2: Adapted from Doshi et al, HVNI in the Treatment of Respiratory Failure, Ann of Emerg Media, 2017;1:11.

In addition to these data, a subgroup analysis of patients with a primary diagnosis of Acute Decompensated Heart Failure (ADHF) was recently published. For this subgroup, high velocity therapy and NiPPV also had statistically equivalent outcomes.

I’m not sure I believe you, what are some ways I could try this and see for myself?

If you can think of patients who truly struggle with the mask and recall all the time you or your team have spent with anxious patients, coaching or medicating or even unfortunately intubating them, but are skeptical about an alternative, here are three easy ways to familiarize yourself with high velocity therapy:

  1. The No Mask. No Problem. e-book is a comprehensive explanation of the theory behind the innovative technology, contains suggested starting parameters depending on patient populations, as well as an in-depth look at clinical study outcomes.
  2. If you’d like a hands-on trial, the friendly, knowledgeable Vapotherm® field team is available for on-site demos and can discuss setting up clinical validations so you can gather your own data from experience.
  3. If you already have Vapotherm high velocity therapy, specifically in your Emergency Department, but haven’t used it for ventilatory support, let us know and we’ll provide you with an opportunity to sign our ED Guarantee program agreement. Under this program, if you place an NIPPV intolerant ED patient on high velocity therapy and that patient fails back to NiPPV or to mechanical ventilation, then in accordance with the agreement, Vapotherm will either replace or reimburse you for the cost of your disposable patient circuit. If you’d like to learn more, you can contact us here.

No Mask. No Problem. Mask-Free NIV

REFERENCES
[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) https://www.ncbi.nlm.nih.gov/pubmed/23562934
[2] Doshi, Pratik et al. High-Velocity Nasal Insufflation in the Treatment of Respiratory Failure: A Randomized Clinical Trial. Annals of Emergency Medicine, 2018. https://www.ncbi.nlm.nih.gov/pubmed/29310868