Anyone out there with experience using the Vapotherm device? i am interested in experience with all pt. populations although I would love to hear about it's use with neonates or pediatric patients. Is high flow really making an impact on hte need for CPAP in preterm infants?
We use a lot of high flow n/c in our NICU. Even on infants less than 1000grams. Our preference is the Fisher-Paykel. It does not have the infection control issues that have plagued the Vapotherm. (I am referring to the cleaning of the cartridge.) The Fisher's are all disposable circuits and the turn around time is very quick. We use flows from 8lpm down to 0.5lpm. And yes, It does make a great deal of difference in comparison to a traditional n/c.
I would like to add an addendum to my statement on HFNC w/the Fisher Paykels. It has come to recent light that any n/c flow greater than 3lpm creates a tremendous backflow and is ill advised for the infant. FP has come out with a pop off valve that releases at greater than 3lpm.That then means that you can increase the liter flow as much as you like, but it will not be delivered due to the pop off valve. However, HFNC is the way of the future. Just a few more bugs to work out. Was all that clear as mud???
We have been using vapotherms on all patient populations with great success for a while now. However, they have all recently been recalled due to problems with the cleaning procedure.
Dear Tig, We had the same problem here at Walt Whitman Memorial in Mahi Mahi, FL. We found to overcome the backflow, we increased our forward flow Q 30 minutes times one minute TID (and one minute more PRN). The forward flow needs to be increased at least by 7.34LPM in order for the Coanda Effect to overcome the precipitant that often rains out during the Venturi effect. Keeping Boyles law in mind, we customized our thermal setting to optimize the digital read-out on our Flux capacitor. Of course, you must monitor electrolytes frequently in order to avoid excess transcorditance of the nasal membranes. We have found that laminar turbulant flow is best to overcome the resistance of viscous secretions. This should eradicate your backflow problems, unless you want backflow for example to reduce a pneumothorax or simulate reverse I:E ratio. We will be glad to send you our protocol for backflow avoidance if you would like. Please advise.
We just started using the F & P's in our nicu and was wondering what temp. setting is optimal? we have found that setting it at 31, the lo heat alarm chirps quite often. when we set it at 37, we get quite a bit of rain out. any suggestions?
Are you referring to NIV or invasive ventilation? As far as F&P is concerned, 37 is the only setting for intubated patients and should be left there. If you are comparing it to the older F&P models, the setting is equivalent to 40 - 3. The chamber and heating wire heat up the inspired gas to 40 deg at the distal temperature probe, then the F&P studies show that the temperature will drop 3 degrees by the time the gas reaches the carina. This was told to me by a senior F&P product manager, and I believe they have some interesting studies on their website. They claim that this is the only way to keep the airway in optimum condition, at lower temps the humidity levels are not high enough, causing poor ciliary clearance, thicker secretions etc. As for the rainout, anyone who can solve it will answer the million dollar question. One of the most common causes is having the ventilator tubing under airconditioning vents: you are guaranteed to have buckets of rainout. Flimsy disposable tubing can also cause a problem. Also, most of the new disposable circuits do not have water traps, which makes it hard to extract the condensate once it happens. I recall seeing a neoprene or similar tubing cover for the tubing available somewhere, just not sure where. In a department where I used to work we sometimes used aluminium foil or pillow slips to insulate the tubing.
breathsaver, I would love to see your back pressure policy on HFNC. Rumor has it that Fisher-Paykel will not make anymore circuits that do not have pop-off valves. And they don't recommend flows greater that 3lpm any longer. Does nursing have a sxing protocol for n/c infant's? We have found secretions to be an issue for failure on HFNC. And in regards to RTNYC, I didn't know the FP's had an adjustable temp setting. 36-37cel should be pretty standard practice. And you are going to have rainout with larger bore tubing. Anyway, my email address is tigngin@hotmail.com thx in advance for the policy's.
breathsaver, I also would like to know if you calibrate your o2 analyzer on 21% in line with the Fisher flow running ?? Otherwise, do you not have your analyzer reading a falsely higher Fio2? Just curious.
