The Seven Types of Patients That Could Benefit from High Velocity Nasal Insufflation

High Velocity Nasal Insufflation (HVNI) delivered with Hi-VNI® Technology is mask-free noninvasive ventilation (NIV) for spontaneously breathing patients. It is a viable alternative to NiPPV and can relieve undifferentiated respiratory distress, including hypercapnia and hypoxemia.11. 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/29310868Read Full Text It is one simple tool that could benefit a variety of patients from neonate to end-of-life.

1. Premature Babies
Baby on Vapotherm
Vapotherm®’s Hi-VNI Technology is a safe and efficacious22. McQueen M, Rojas J, Sun Shyan, Tero R, Ives K, Bednarek F, Owens L, Dysart K, Dungan G, Shaffer T, Miller T. “Safety and long term outcomes with high flow nasal cannula therapy in neonatology: a large retrospective cohort study.” J Pulm Respir Med. 2014 Dec; 4(6): 216.Read Full Text mask-free alternative to CPAP3,43. 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.Read Full Text

4. Collins C, Holberton J, Barfield C, Davis P. “A randomized controlled trial to compare heated humidified high-flow nasal cannulae with nasal continuous positive airway pressure postextubation in premature infants.” J Pediatrics. 2013 May; 162: 949-54.Read Full Text
for neonates. During the vulnerable first days, when it is critical for babies to focus on growing, Hi-VNI Technology is a gentle approach for primary33. 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.Read Full Text and post-extubation44. Collins C, Holberton J, Barfield C, Davis P. “A randomized controlled trial to compare heated humidified high-flow nasal cannulae with nasal continuous positive airway pressure postextubation in premature infants.” J Pediatrics. 2013 May; 162: 949-54.Read Full Text support. The open system and mask-free interface reduces the risk of skin breakdown and facilitates kangaroo care, letting families bond and allowing babies to be babies first.

2. Pediatric Patients

One of the most common forms of respiratory distress in pediatric patients is caused by bronchiolitis. Children’s skin is generally more fragile and so they benefit from the easy-to-tolerate gentleness of a mask-free interface. In addition to that, the optimally conditioned medical grade vapor55. Waugh J, Granger W. An evaluation of 2 new devices for nasal high-flow gas therapy. Respiratory Care. 2004 Aug; 49(8): 902-906.Read Full Text created by Hi-VNI Technology can help relieve symptoms associated with bronchiolitis by promoting mucociliary clearance.66. Hasani A, Chapman TH, McCool D, Smith RE, Dilworth JP, Agney JE. Domiciliary humidification improves lung mucociliary clearance in patients with bronchiesctasis. Chronic Respiratory Disease. 2008; 5: 81-86.Read Full Text

Hi-VNI Technology is also compatible with aerosol delivery. For a survey of practice guidelines, you can download our Aerosol Delivery with HVNI Pocket Guide.

3. Flu Patients

X-Ray - Day of Admission - 5 Days Later

Although individual results may vary, Vapotherm believes this patient’s experience at Gaylord hospital is an example of the clinical benefit Vapotherm’s humidification can have in an LTACH setting.

Pneumonia is one of the serious complications of the flu. As with all congested patients, one of the keys to recovery is ensuring secretion clearance. Hi-VNI Technology provides optimally conditioned gas that promotes secretion clearance.77. Rea H, McAuley S, Jayaram L, Garrett J, Hockey H, Stoey Louanne, O’Nonnell G, Haru L, Payton M, O’Donnell K. The clinical use of long-term humidification therapy in chronic airway disease. Respiratory Medicine. 2010 Apr; 104(4): 525-533.Read Full Text The image to the right comes from Gaylord Hospital in Wallingford, CT. The patient was placed on Hi-VNI Technology on the day of admission. The staff employed standard clinical care and did not employ any additional mechanisms for secretion mobilization. The X-ray taken five days later demonstrates the effectiveness of Hi-VNI Technology in secretion mobilization.

4. Bearded Patients and Others Whose Facial Proportions May Prevent Mask Seals

Bearded maleClinicians treating respiratory distress patients may be familiar with the frustration of wasting critical time speed-shaving a patient to ensure an NiPPV mask will have a proper seal. The advantage of a mask-free system for this type of patient is easy to recognize. A recent randomized, controlled, multi-center trial has shown that HVNI has the same clinical efficacy as NiPPV11. 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/29310868Read Full Text in treating undifferentiated respiratory distress in adults, but due to the mask-free interface, HVNI eliminates the need for a mask seal. The mask-free interface not only enhances patient comfort but offers clinicians an easy-to-use tool at the front-lines of respiratory care. When asked about simplicity of use, clinicians11. 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/29310868Read Full Text rated HVNI more highly than NiPPV.

5. Patients Presenting in Undifferentiated Respiratory Distress in the Emergency Department

Hi-VNI Technology is a simple front-line tool for treating patients presenting in the Emergency Department in undifferentiated respiratory distress, including hypercapnia and hypoxemia.11. 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/29310868Read Full Text Clinicians not used to Hi-VNI Technology may express surprise at the idea of an open system being able to relieve hypercapnia, but as Figure 1 illustrates, there is no significant difference between Hi-VNI Technology and NiPPV when it comes to the reduction of CO2 in adult patients. This allows emergency department clinicians to have one comfortable go-to tool when admitting patients in respiratory distress.


Hi-VNI Technology
efficiently reduces CO2

Velocity graph

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



6. Patients with Mask-Intolerance and Mask Anxiety

Patients with mask-intolerance present a familiar problem to clinicians prescribing NiPPV to relieve respiratory distress. Studies show that more than 30% of NIV failure is attributed to patients who are mask-intolerant.88. 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/23562934Read Full Text Techniques for reducing anxiety such as coaching, or sitting with patients, may increase intensity of care. Additionally, patients failing NiPPV and having to be intubated results in both increased risks and costs. Hi-VNI Technology offers a viable, mask-free alternative to NiPPV, particularly for the mask-intolerant patient.

Figure 2 illustrates just such a case of an NiPPV intolerant patient placed on Hi-VNI Technology. You can read the full case study here.


Chronological Patient Vital Signs



Chronological Patient Vital Signs

Figure 2: Case Study of NiPPV intolerant patient successfully stabilized with Hi-VNI Technology.



7. End-of-Life Palliative Care Patients

End of life with VapothermComfort is a priority when it comes to palliative care patients. Rather than spending their last days and hours with their face behind a mask, end-of-life patients and their families prefer to be able to talk to their loved one and see them smile. With Hi-VNI Technology, palliative care patients can receive the gentle and effective respiratory support they need while still being able to talk, eat, drink, and take oral medication. The mask-free patient interface reduces the risk of skin breakdown and enhances comfort as compared to mask therapies.

Upcoming Webinar

Join Vapotherm for a webinar on the latest clinical research on High Velocity Nasal Insufflation (HVNI). Our presenter will share their clinical experience using HVNI as a front line tool for treating the signs and symptoms of respiratory distress in the Emergency Department. HVNI uses high velocity, high flows of humidified gas, delivered through a small-bore nasal cannula to not only improve oxygenation but also ventilation efficiency.

1 CEU/Contact Hour
January 23rd, 1PM – 2:00PM EST

Presented by:

Ross Simcoe, MD
Emergency Physician
Our Lady of Lourdes, Team Health, EMCare, Charles Cole Memorial Hospital

No mask? No problem.
Mask-Free NIV

for Spontaneously Breathing Patients


Webinar Registration

References

1. 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
2. McQueen M, Rojas J, Sun Shyan, Tero R, Ives K, Bednarek F, Owens L, Dysart K, Dungan G, Shaffer T, Miller T. “Safety and long term outcomes with high flow nasal cannula therapy in neonatology: a large retrospective cohort study.” J Pulm Respir Med. 2014 Dec; 4(6): 216.
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. Collins C, Holberton J, Barfield C, Davis P. “A randomized controlled trial to compare heated humidified high-flow nasal cannulae with nasal continuous positive airway pressure postextubation in premature infants.” J Pediatrics. 2013 May; 162: 949-54.
5. Waugh J, Granger W. An evaluation of 2 new devices for nasal high-flow gas therapy. Respiratory Care. 2004 Aug; 49(8): 902-906.
6. Hasani A, Chapman TH, McCool D, Smith RE, Dilworth JP, Agney JE. Domiciliary humidification improves lung mucociliary clearance in patients with bronchiesctasis. Chronic Respiratory Disease. 2008; 5: 81-86.
7. Rea H, McAuley S, Jayaram L, Garrett J, Hockey H, Stoey Louanne, O’Nonnell G, Haru L, Payton M, O’Donnell K. The clinical use of long-term humidification therapy in chronic airway disease. Respiratory Medicine. 2010 Apr; 104(4): 525-533.
8. 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
2019-01-04T13:51:49+00:00Dec 10|Vapotherm Blog|