Frequently Asked Questions for use of Vapotherm High Velocity Nasal Insufflation in Emergency Medicine
High Velocity Nasal Insufflation (Hi-VNI® Technology) is a refined form of High Flow Nasal Cannula (HFNC) that uses a small-bore nasal cannula to effectively washout expiratory gas from the extra-thoracic dead space. Hi-VNI Technology not only facilitates oxygenation but also augments alveolar ventilation. Hi-VNI reduces work of breathing (WOB) by providing high flows and high velocities of heated and humidified breathing gas through a simple nasal cannula. Patients experience acute symptom relief, and mask-free delivery improves patient comfort and simplifies nursing care.
The primary mechanism of action is washout of CO2 from the nasopharyngeal dead space between breaths and replacement with fresh breathing gas to allow the patient to breathe from rather than through the upper airway. A secondary mechanism is a low level of Positive Expiratory Pressure (PEP). In addition the heat and humidity that makes the high flow rates comfortable also helps mobilize vsecretions, soothe, and relax irritated respiratory tissue.
Hi-VNI Technology treats the signs and symptoms of respiratory distress and is appropriate for patients experiencing high work of breathing, air hunger, hypoxemia and hypercapnia. Patients must be spontaneously breathing, alert and oriented and have the ability to protect their airway. Hi-VNI Technology has been used as a tool to effectively support patients experiencing the signs and symptoms of respiratory distress with a primary diagnosis of CHF, COPD, asthma, pneumonia, emphysema, bronchitis, RSV bronchiolitis, influenza, chronic pulmonary diseases and general dyspnea. Hi-VNI Technology can be used to support patients of all ages from newborns to geriatric patients by selecting appropriate flow rates and cannula sizes. Hi-VNI Technology should not be used in situations where humidification is contraindicated, or with patients that have occluded or defective nares.
Patients often experience acute symptom relief showing a decrease in respiration rate and work of breathing.
Like NIPPV, Hi-VNI Technology can be used effectively as a first line tool to treat the signs and symptoms of respiratory distress and reduce the need for mechanical ventilation in spontaneously breathing patients. Patients that require pressure to stent the airway are more appropriately treated with NIPPV.
Hi-VNI Technology is generally well tolerated and requires no special fitting of masks or patient education. The optimal heating and humidification of the breathing gas makes even very high flow rates comfortable. The nasal cannula delivery allows patients to speak, drink, take oral medications, and participate in their care.
Hi-VNI Technology sets up heated and ready to use within 5 minutes. Patients experience acute symptom relief and none of the tolerance or feelings of claustrophobia often seen with mask-based therapy. In addition, nursing care is simplified because no time is spent taking masks off and on for drinks and oral med delivery, and the patient is able to answer questions and speak with clinicians while on therapy.
Hi-VNI Technology can be delivered outside of the ICU as long as there is availability of oxygen, compressed air and oximetry monitoring for the patient. Weaning Hi-VNI Technology is simple, and many patients are weaned off of therapy in the ED once medications have had time to impact the root cause of the respiratory distress (e.g., fluid retention in CHF patients or exacerbated airway resistance in COPD patients), allowing admission to a unit with a lower intensity of care.
Current users have seen a substantial cost benefit through reducing ICU admissions, and NIPPV rental. EDs report reduced intensity of care for admissions (shorter ICU LOS or stay on GCF), with increased ED throughput due to shorter setup times, faster patient stabilization and symptomatic relief. Moreover, patient tolerance and compliance is greatly improved which can mean fewer escalations to intubation.
For transfer of patients with uninterrupted Hi-VNI Technology, a Vapotherm Transfer Unit (VTU) is available which uses a battery power supply and gas tanks mounted on a roll stand to allow transfer of patients within the hospital without disruption of therapy. The VTU switches seamlessly between wall and tank support and alternatively the patient circuit can be easily hot-swapped onto a standing unit at the patient bedside once the patient has been transferred.