Emergency Medicine High Velocity Nasal Insufflation (Hi-VNI) VAPOTHERM POCKET GUIDE

Emergency Medicine High Velocity Nasal Insufflation (Hi-VNI) VAPOTHERM POCKET GUIDE

Indications for Vapotherm High Velocity Nasal Insufflation (Hi-VNI ) administration, the patient should be: Spontaneously breathing Alert and oriented Has a protected airway Patient Selection SYMPTOMS: Signs and Symptoms: Patients presenting with one or more of the following may be candidates: General Dyspnea NiPPV Intolerant Hypercapnia Refractory Hypoxemia Increased cardiac workload Increased Work of Breathing Diagnoses CONDITIONS: These symptoms are indicative of but not solely attributed to: Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD) Mild or Moderate Congestive Heart Failure (CHF) Asthma Pneumonia Bronchitis Bronchiolitis Influenza 1 Vapotherm Emergency Medicine Pocket Guide

Cannula Selection & Application FITTING THE CANNULA: Cannula Sizes Cannula Flow Range Tip OD Pediatric Small Up to 20 L/min 1.9 mm Pediatric/Adult Small Up to 40 L/min 2.7 mm Adult Large Up to 40 L/min 4.8 mm Vapotherm offers 8 different size cannulae to effectively fit patients. Not shown are the intermediate infant, infant, SOLO, neonatal, and premature. These cannulae are designed for neonatal patients. Only Vapotherm cannula should be used with the Vapotherm Precision Flow. Cannulae should be sized not to occlude greater than 50% of the nares Cannula prongs should be spread enough not to pinch the nasal septum (erosion risk) CANNULA APPLICATION: Select the appropriate cannula based on the above chart Allow the system to reach desired temperature (temperature display will stop flashing) before connecting the delivery tube to the cannula The Precision Flow s operational flow range is locked at 5-40 L/min for the High Flow Disposable Patient Circuit (blue packaging) Note: There is a low flow disposable patient circuit available specifically for neonatal applications. Vapotherm Emergency Medicine Pocket Guide 2

Clinical Use Guidelines ASSESS THESE PARAMETERS TO DETERMINE THERAPY INITIATION: PaO 2 < 80 mmhg SaO 2 < 90% PaCO 2 > 45 mmhg Tachycardia Tachypnea Start with high flow rates (35-40 L/min) and titrate down to effect Hypoxemia Start Titrate to Effect FLOW 40 L/min Comfort/ventilatory effect O2 100% Desired SpO 2 TEMP. 37ºC Comfort/secretion mobilization Hypercarbia (increased WOB) Start Titrate to Effect FLOW 40 L/min Titrate to effect comfort/ventilatory effect O2 35% Desired SpO 2 TEMP. 37ºC Comfort/secretion mobilization 3 Vapotherm Emergency Medicine Pocket Guide

ED Frequently Asked Questions WHAT IS VAPOTHERM HIGH VELOCITY NASAL INSUFFLATION (HI-VNI TM )? High Velocity Nasal Insufflation (Hi-VNI) 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 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 rapid symptom relief, and mask-free delivery improves patient comfort and simplifies nursing care. WHAT PATIENTS ARE CANDIDATES FOR HI-VNI IN THE ED? Hi-VNI 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. Hi-VNI has been used to effectively support patients with a primary diagnosis of CHF, COPD, asthma, pneumonia, emphysema, bronchitis, bronchiolitis, influenza, chronic pulmonary diseases and general dyspnea. Hi-VNI should not be used in situations where humidification is contraindicated, or with patients that have occluded or defective nares. HOW QUICKLY DOES HI-VNI STABILIZE PATIENTS? Patients often experience rapid symptom relief showing a decrease in respiration rate and work of breathing within minutes of applying the therapy. Anecdotally, you know if a patient will be a responder within the first 10-15 minutes. CAN I USE HI-VNI IN PLACE OF OTHER FORMS OF NONINVASIVE POSITIVE PRESSURE VENTILATION (NIPPV)? Like NIPPV, Hi-VNI can be used effectively as a first line therapy for 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. HOW EASILY DO PATIENTS TOLERATE HI-VNI? Hi-VNI 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. DO PATIENTS NEED TO GO TO THE ICU ONCE PLACED ON HI-VNI? Hi-VNI 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 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 allowing admission to a unit with a lower intensity of care. Vapotherm Emergency Medicine Pocket Guide 5

Vapotherm, Inc. 22 Industrial Drive Exeter, NH 03833 603.658.0011 www.vapotherm.com MKT-0045 Rev. D 8/16