Vapotherm, Inc. is the market leader in high-flow, thermally-controlled, humidification systems for respiratory therapy. Currently, these medical devices are indicated for use in adding warm moisture to breathing gases to infant, pediatric and adult patients in the hospital, sub-acute institutions and home settings. Vapotherm devices are cleared for delivery of breathing gases by nasal cannula at flow rates of up to 8 lpm in infants and 40 lpm in adults, providing what is known as high flow therapy (HFT).
What is High Flow Therapy (HFT)?
HFT is defined as flow rates that exceed patient inspiratory flow rates at various minute volumes. Historically, high flow therapy has been used with face masks, where the high flows flush the mask volume to facilitate high inspiratory oxygen fractions. While effective in supporting oxygenation, mask therapy can be limited by factors including ability to eat/drink and communicate, as well as feelings of claustrophobia, leading to poor patient compliance. The standard nasal cannula has been the standby for better compliance and patient comfort. Cannulae provide supplemental oxygen, are comfortable for long periods and allow patients to eat and talk without interruption of the therapy. However, higher flows (over 2 lpm in neonates or 6 lpm in adults) needed to meet inspiratory requirements without allowing entrainment of room air are not possible with conventional nasal cannula therapy. This limitation to conventional cannula therapy is a result of the discomfort and irritation caused by delivering cold, dry gas to the nasal passages. Vapotherm's technology has transformed conventional cannula therapy through optimal conditioning of breathing gas.
Click here to download the White Paper, High Flow Therapy and Humidification: A Summary of Mechanisms of Action, Technology and Research
Click here to download the White Paper, Role of Pressure In High Flow Therapy
Click here to download the new presentation, High Flow Therapy: Mechanisms of Action
How High Flow Therapy (HFT™) via nasal cannula works?
Conventionally, HFT™ refers to oxygen therapy by way of a non-rebreather mask. The mask is flushed with gas flows that exceed a patient's inspiratory flow rates, and the mask serves as a reservoir of fresh gas. These two conditions eliminate entrainment of room air during inspiration so that a patient can breathe high fractions of oxygen, or breathe whatever gas mixture is intended without dilution by ambient gas.
This video clip from Dr. Brian L. Tiep (Respiratory Disease Management Institute, Monrovia, California) of a head model using a non-rebreather mask shows how the mask works as a reservoir to allow a patient to inspire a given gas mixture. Note that the inspiratory gas still mixes with the end-expiratory gas remaining in the nasopharynx.
Link to non-rebreather mask video
HFT™ using a nasal cannula will accomplish the same goal as a non-rebreather mask, but uses the nasopharynx as the gas reservoir.
This clip from Dr. Tiep shows how efficiently a nasal cannula can work for HFT™. Note that when the nasopharynx is the reservoir, the inspiratory gas is not diluted by end-expiratory gas remaining in this region of the airways. Therefore, HFT™ by nasal cannula is more efficient than a non-rebreather mask. Also, consider the impact that this flush of end-expiratory gas has on CO2 removal.
Link to nasal cannula video
High Flow Therapy Via Cannula
Can enhance respiratory efficiency by flushing nasopharyngeal
anatomical dead space and support respiratory work
