off. Approximately three weeks ago, she presented with a similar exacerbation, was intubated, and had a three-day stay in the ICU. Michael, the attending physician, orders NIPPV, although he knows Susan often struggles with the mask. Perhaps some analgesia will help her to relax enough to tolerate NIPPV this time. It is that or intubation again. But what if there were a mask-free form of NIPPV? Michael's EM physician colleague, who also has treated Susan before, suggests vapotherm high-velocity therapy, which she believes will provide the needed support with a more comfortable nasal cannula patient interface instead of a mask. Michael can't help but wonder how a nasal cannula system can provide ventilation without pressure to which his colleague says that it comes down to an equation he might remember from school. She reminds Michael that alveolar ventilation is tidal volume minus dead space multiplied by the respiratory rate. Pressure-based therapies, such as NIPPV, have been used almost exclusively to provide non-invasive ventilation. NIPPV increases tidal volume by pushing air into the lungs using pressure. High-velocity therapy reduces the dead space, which typically is about 30% of the adult airway, by continuously flushing the oral, nasal, and pharyngeal cavities of exhaled gas, high in carbon dioxide, and replacing it with oxygen-rich fresh gas. Both help the patient achieve alveolar ventilation. High-velocity therapy is an advanced form of high flow. While high velocity and high flow oxygen both flush the anatomical dead space, they are mechanistically different. High-velocity therapy uses a small-bore nasal cannula that can deliver the same flows at much higher velocities than large-bore nasal cannula high-flow oxygen systems. For example, high-velocity therapy delivers 40 liters per minute of flow at a velocity many times that of a high-flow oxygen system at 60 liters per minute. This matters because the more tachypneic a patient is, the less time there is between breaths to wash out the dead space. Higher-velocity flows result in more efficient dead space flush, which is key to providing ventilatory support. This is in part why vapotherm high-velocity therapy is clinically indicated for oxygenation and ventilatory support. And in Susan's case, she needs ventilatory support. Michael is pleased to see Susan quickly begins to relax, and her respiratory rate decreases from her baseline, and after a while, she shows noticeably less effort. The ABG also shows a PaCO2 drop, and her pH improved. Michael admits Susan to the medical floor, and she is discharged the following day. Outcomes like these are possible with Vapotherm's mask-free NIV. Discover more at Vapotherm.com.

Vapotherm

high-velocity therapy

nasal cannula

ventilatory support

ABG results