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.
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.