Download FAQs for use of Vapotherm HFT in the Emergency Department

 Frequently Asked Questions for use of Vapotherm High Flow Therapy in the Emergency Department What is Vapotherm High Flow Therapy? Vapotherm High Flow Therapy (HFT) is a type of high flow nasal cannula (HFNC) that uses small sized nasal prongs to assure effective flush of exhaled CO2 from the upper airway in addition to oxygenation support. HFT reduces work of breathing (WOB) by providing high flow rates of heated and humidified oxygen rich breathing gas through a simple nasal cannula. Patients experience rapid symptom relief, and mask-­‐free delivery improves patient comfort and simplifies nursing care. What is the mechanism of action for respiratory support? The primary mechanism of action is flush of CO2 from the upper airway and nasopharyngeal dead space between breaths and replacement with oxygenated 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) created by high flows. In addition the heat and humidity that makes the high flow rates comfortable also helps mobilize secretions, soothe, and relax irritated respiratory tissue. What patients are candidates for HFT in the ED? HFT treats 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. HFT has been used to effectively support patients with a primary diagnosis of CHF, COPD, asthma, pneumonia, emphysema, bronchitis, RSV bronchiolitis, influenza, chronic pulmonary diseases and general dyspnea. HFT can be used to support patients of all ages from newborns to geriatric patients by selecting appropriate flow rates and cannula sizes. HFT should not be used in situations where humidification is contraindicated, or with patients that have occluded or defective nares. How quickly does HFT stabilize patients? Patients often experience rapid symptom relief showing a decrease in respiration rate and work of breathing within minutes of applying the therapy. Can I use HFT in place of other forms of NIPPV? Like NIPPV, HFT can be used effectively as a first line therapy to respiratory support to reduce the need for mechanical ventilation in spontaneously breathing patients. Patients that require pressure to stent the airway are more appropriately treated with NIPPV. Vapotherm Inc.
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22 Industrial Drive, Exeter, NH 03833 - (603) 658-0011 -
www.vtherm.com
3100425 Rev. B
How easily do patients tolerate HFT? HFT 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. How does HFT impact ED workflow? HFT sets up heated and ready to use within 5 minutes. Patients experience rapid 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. Do patients need to go to the ICU once placed on HFT? HFT can be delivered outside of the ICU as long as there is availability of oxygen, compressed air and oximetry monitoring for the patient. Weaning HFT 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. What are the economic benefits of using HFT in the ED? Current users have seen a substantial cost benefit through reducing ICU admissions, and NIPPV rental. EDs using HFT 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. How can I transfer admitted patients while on HFT? For transfer of patients with uninterrupted HFT, 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. Vapotherm Inc.
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22 Industrial Drive, Exeter, NH 03833 - (603) 658-0011 -
www.vtherm.com
3100425 Rev. B