What Spectrum of Patients Can Go On High Velocity Therapy? — An Emergency Physician Discusses

Vapotherm’s high velocity therapy is a tool for can treating respiratory distress. Vapotherm does not practice medicine or provide medical services or advice, any clinical recommendations provided herein are solely those of the speakers. Practitioners should refer to the full indications for use and operating instructions of any products referenced before use.

High Velocity Therapy is Mask-Free NIV for spontaneously breathing patients, and as such it is a viable alternative to non-invasive positive pressure ventilation (NiPPV).[1] It can be an especially useful tool in the Emergency Department (ED) where physicians don’t yet know what exactly is wrong with the patients, but have to treat their respiratory distress quickly. The mask-free interface is easy-to-tolerate which is why mask-intolerant and anxious patients may prefer it. But exactly what patients do physicians put this technology on?

Vapotherm’s® VP of Medical Affairs, Michael McQueen, MD had a conversation with emergency physicians to address this question, among others.

Kirk Hinkley, MD, FACEP volunteered his candid experience, explaining that if a patient only needs a little bit of nasal cannula oxygen, he doesn’t use high velocity therapy. On the other end of the spectrum, the people he knows will need to be intubated, he puts them on high velocity therapy in order to prepare them for intubation. However, he also shared that in some instances patients he thought would need intubation ended up being rescued by this technology. You can watch the excerpt of his discussion below.

I continue to use it with good results and I will continue to use it, again, while I try to sort out what’s wrong with these folks.” — Kirk Hinkley, MD, FACEP

How Does High Velocity Therapy Work?

High velocity therapy is a user-friendly tool that could benefit a variety of patients, from neonate to end-of-life.

It employs a mask-free interface, which is easy to tolerate and patients can eat, drink, and talk while on the therapy. Although high velocity therapy operates in part based on L/min selection, it is not a commodity high flow oxygen product, and although it can offer ventilatory support, its primary mechanism of action is velocity not pressure. High velocity therapy rapidly flushes end-expiratory CO2 from the upper airway and has been clinically demonstrated to be as effective as NiPPV in treating undifferentiated respiratory distress in adults, including hypercapnia.[1]

This combination of beneficial aspects of commonly used respiratory support modalities makes high velocity therapy a particularly good solution for spontaneously breathing patients who require ventilatory support, yet have a hard time tolerating a tight-fitting mask.

Learn More through ED physician discussion highlights

[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