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Vapotherm and High Flow nasal cannula
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<RTNYC>
posted
on the new heaters, there are 2 temp settings. intubated (37) and non-intubated (31).

obviously, my assumption is that 31 isn't enough to heat the airways. this setting provides little rain out.

when we run the temp at the intubated temp setting (37) we get a lot of rain out and have to drain the tubing quite often. having to remove the cannula and drain the water from that as well. it's a pain in the butt if u ask me.

we also like to run the flows pretty high which isn't recommended; usally at 4-5 l/m

i think the vapotherms worked a lot better in this sense. never had to deal with rain out issues or back flow.
 
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<Hartj17>
posted
With the recent problems of Vapotherm Fisher-Paykel has come up with another system. I caution all of you when using this in the neonatal and pediatric setting though. Recent research in our facility (Wilford Hall Medical Center, San Antonio Texas) has shown that pressure inside the delivery curcuit reach upwards of 270mm/hg without a pop off valve. Methodist Childrens Hospital while first using this system without a pop off valve actually has a system explode while in use. The pop off valve is measured at 40ccH2o which depending on the cannula size your using gives you between 1.5 lpm on a Neonate, and 2.5 lpm on a pediatric. Remember, if the cannula rides on the septum liter flow will be compromised. This also includes water build up within the circuit.
 
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Junior Member
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Greetings...

I'm new to the board and I hope that I'm not too late to ask a couple of questions on this topic...

We sent back out vapo set ups when they were recalled and we have been using a system of our own design that uses a F&P heater and vent circuit connected to a NC. We have had very few problems with the set up but we are interested in research that is going on with HFNC.

We have F&P set ups in house now but I'm starting to wonder about their effectiveness and safety. Can anyone point me in the right direction? Internet searches have only led me to Vapo studies. Has any one studied any other systems? How about just using HFNC without heated humidifiers? Are there really no studies out there?

Thanks in advance for any and all assistance...

Evan RRT
 
Posts: 2 | Registered: February 10, 2006Reply With QuoteReport This Post
<RTNYC>
posted
I've been looking for the same data but no luck so far.

I would think using HFNC w/o heated humidity especially in the neo/pediatric population would be a huge no no. u really should be providing some sort of heat to the airways.
 
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Junior Member
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RTNYC,

We have been using a F&P heated circuit when using high flow NC. Only transition patients get away with a bubbler (for short term use - only less than 6 hours). The problem is there is no data to suggest how effective this system is in these patients. Does anyone know of any studies that are in process? Our docs here want to start up a study but I would rather not reinvent the wheel if at all possible. I just can't imagine that High Flow NC has gone unstudied...

Thanks again.

Evan RRT
 
Posts: 2 | Registered: February 10, 2006Reply With QuoteReport This Post
<Natalie>
posted
Hello,
We have switched to the Fisher/Paykel system a few months ago. We are finding that using the popoff limits the effectiveness. Physicians are divided on this. If a patient fails with the popoff some physicians will order the popoff taken out of line so they can increase flows. They are not interested in placing the patient on a CPAP device. So we are looking for more information to develop a policy. Can you send me your research that you did on the popoffs.
Thanks,
Natalie

QUOTE]Originally posted by Hartj17:
With the recent problems of Vapotherm Fisher-Paykel has come up with another system. I caution all of you when using this in the neonatal and pediatric setting though. Recent research in our facility (Wilford Hall Medical Center, San Antonio Texas) has shown that pressure inside the delivery curcuit reach upwards of 270mm/hg without a pop off valve. Methodist Childrens Hospital while first using this system without a pop off valve actually has a system explode while in use. The pop off valve is measured at 40ccH2o which depending on the cannula size your using gives you between 1.5 lpm on a Neonate, and 2.5 lpm on a pediatric. Remember, if the cannula rides on the septum liter flow will be compromised. This also includes water build up within the circuit.[/QUOTE]
 
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<N Rivera>
posted
Hello:
We use this system too, in Chile (Sud America). Would you explain to me in detail backflow effect?
Thanks
 
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<debbie NPS<RRT>
posted
quote:
Originally posted by Natalie:
Hello,
We have switched to the Fisher/Paykel system a few months ago. We are finding that using the popoff limits the effectiveness. Physicians are divided on this. If a patient fails with the popoff some physicians will order the popoff taken out of line so they can increase flows. They are not interested in placing the patient on a CPAP device. So we are looking for more information to develop a policy. Can you send me your research that you did on the popoffs.
Thanks,
Natalie

QUOTE]Originally posted by Hartj17:
With the recent problems of Vapotherm Fisher-Paykel has come up with another system. I caution all of you when using this in the neonatal and pediatric setting though. Recent research in our facility (Wilford Hall Medical Center, San Antonio Texas) has shown that pressure inside the delivery curcuit reach upwards of 270mm/hg without a pop off valve. Methodist Childrens Hospital while first using this system without a pop off valve actually has a system explode while in use. The pop off valve is measured at 40ccH2o which depending on the cannula size your using gives you between 1.5 lpm on a Neonate, and 2.5 lpm on a pediatric. Remember, if the cannula rides on the septum liter flow will be compromised. This also includes water build up within the circuit.
[/QUOTE]
 
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<debbie,nps,rrt>
posted
We are currently using the Fisher- Paykel HHNC and feel that the flows aren't sufficient for some infants. Some of my docs want to take the pop off off in order to use higher flows....has anyone had any adverse reactions from this...What is max. flow you have used???



quote:
Originally posted by debbie NPS<RRT:
quote:
Originally posted by Natalie:
Hello,
We have switched to the Fisher/Paykel system a few months ago. We are finding that using the popoff limits the effectiveness. Physicians are divided on this. If a patient fails with the popoff some physicians will order the popoff taken out of line so they can increase flows. They are not interested in placing the patient on a CPAP device. So we are looking for more information to develop a policy. Can you send me your research that you did on the popoffs.
Thanks,
Natalie

QUOTE]Originally posted by Hartj17:
With the recent problems of Vapotherm Fisher-Paykel has come up with another system. I caution all of you when using this in the neonatal and pediatric setting though. Recent research in our facility (Wilford Hall Medical Center, San Antonio Texas) has shown that pressure inside the delivery curcuit reach upwards of 270mm/hg without a pop off valve. Methodist Childrens Hospital while first using this system without a pop off valve actually has a system explode while in use. The pop off valve is measured at 40ccH2o which depending on the cannula size your using gives you between 1.5 lpm on a Neonate, and 2.5 lpm on a pediatric. Remember, if the cannula rides on the septum liter flow will be compromised. This also includes water build up within the circuit.
[/QUOTE]
 
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Junior Member
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We began using the FP heated system in our nicu late last year (07) We typically use flows of 4 and 5 ltres for mild RDS. usually 30 wks + or - 2 wks. we have had great success and have only had to intubate 1 for surfactant and then back to heated cannula. All other infants improved and were off our services within 3 days. The total number was about 10 infants. No cpap was used in this group. Before this we used the Viasys ncpap and had mixed but good results. The infants were on our services longer though, IE; low flow bubble nasal cannula's at .25 to 1 ltre for days to weeks. The cannula system from FP is tollerated much better. The system is totally disposable and easy to set up and clean. We have been asked to look at Vapotherm now and do not wish to change. I do not see the benefit over cost. I am told it is billed as a cannula and has a cost of almost 200.00 to set up not including the man hour time. The FP system costs about 30.00 I am sure the vapotherm system is a great system. I am not sure that it is that much better though. The differance is only 3% on the relative humidity 95% for the FP and the 98% for Vapotherm.

This message has been edited. Last edited by: aldocella,
 
Posts: 1 | Registered: March 05, 2008Reply With QuoteReport This Post
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