2004 OPEN FORUM Abstracts
Vapotherm: A Simple Device becomes a Simple Solution in the PICU
Jennifer Frick, BS, RRT, Katie Sabato, MS,
RRT, and Heidi Flori, MD, Children’s Hospital and Research
Center of Oakland, CA.
Introduction: Routinely when patients
present in respiratory distress, time is limited and many
non-invasive therapies are attempted to treat their symptoms. If
these non-invasive techniques are unsuccessful then clinicians must
choose the more invasive therapy, intubation. We recently began using
a new device called Vapotherm that has provided an alternative useful
noninvasive therapy. We present 4 different case studies that
represent a variety of patients where Vapotherm was used successfully
to treat their level of respiratory distress. In each case, all other
forms of traditional noninvasive respiratory therapies had been
exhausted and or ruled out.
Methods: All 4 patients had
distinctively dissimilar diagnoses that lead to respiratory distress.
Respiratory distress was defined by clinical assessments and
objective physiologic values. Baseline assessments (recorded by PICU
nurses) were made, and then all patients were placed on the
Vapotherm. Once placed on the Vapotherm flows and FiO2
were adjusted to address specific respiratory symptoms and
oxygenation needs. Post-assessments were completed 60-90 minutes
following the application.
Case Summaries:
Pt A. 16
months: Primary pneumonia per CXR, presented with tachypnea
and frequent oxygen destaturations -would not tolerate an oxygen
mask.
Pt B. 14 years: severe chronic asthmatic presenting with
nasal flaring, severe dyspnea and CO2 retention. Baseline therapies
were continuous Albuterol via the Circulaire driven by Helium.
Pt
C. 3 months: Post-op, post extubation cardiac patient with
severe atelectasis on CXR. Baseline therapies included nasal cannula
and Q2 hour CPT.
Pt D. 2 1/2 years: 36 wk ex preemie, RSV,
bronchiolitis, presents in mod. respiratory distress that has been
waxing and waning since the admission, prod cough but unable to
expectorate freely due to the presence of the mask from the
non-invasive bi-level positive pressure device
Results: All
case studies were approved by IRB
Discussion:
In all patients, intubation was avoided and no side effects
associated with the use of high flow therapy where reported. Many
clinicians, however, are not used to or comfortable with the high
flows that are recommended with Vapotherm These patients showed
improved markers of respiratory distress as indicated by improvement
in heart rate, respiratory rate, and oxygen saturation. In addition,
patients all showed subjective improvement in overall comfort and
work of breathing. The Vapotherm with its high-flow well-saturated
humidity seems to be a comfortable, well-accepted therapy. While we
continue to utilize Vapotherm when warranted, we admit that there
remains to be a lot to learn about this device including the
potential level of peep generated by such high flows. Further
research is necessary to evaluate safety and identify optimal patient
populations and applications for this exciting new and simple device.