Vapotherm?

dawngloves, BSN, RN · Jan 6, 2005

We started using it last year. It is great fo the chronics! Right off the vent to VT. No CPAP! Only complaint is that we had trouble with one kid had alot of condensation blowing up her nose.

Anyone else using Vapotherm? Swear I'm not a rep for the company, I'm just pretty impressed. It's essentially a very high flow NC but there is so much heat and humidity that it is well tolerated. The neo-natal flow rates are from 1L to 8L/min then you can blend the FiO2. It's delivered through a pretty standard looking nasal cannula.
The infant I had was a "chronic", only been off the vent for 4 days in his life and was over 100days old. His neo loaded him on steroids and extubated him to the Vapotherm at 6L/min, started at 0.50 FiO2 and eventually held at about 0.30 FiO2. He tolerated very well, didn't have a lot of nasal secretions and what he did have was very thin due to all the humidity being delivered through the system. His CBG's were amazing the next few days. PCO2's from 54-65 which was amazing for this kid even when he was intubated. I had him for his first 6 days on this Vapotherm and he was thriving on it. The Neo was starting to wean his flow the last couple days.
We had just gotten them in the unit in the last few weeks and these were the results we were seeing on most of the kids. We are looking to replace many of the CPAPs with this system. I know they have a website because no one inserviced me on them so I had to seek the information on my own.

Gompers, BSN, RN · Jan 6, 2005

We've also been using Vapotherm for about a year and are loving it!!! The kids like it so much better than CPAP - we have the CPAP with the long nasal prongs, not the one with the cap - even though it's SO loud when its >3LPM! But the only time we use CPAP now is when we need cycled CPAP for really borderline kiddos. From 500 gram micropreemies to 5 kg chronics - we've had them all on Vapotherm with excellent results.

As for the condensation, that is definitely a problem. We've been able to decrease it a little bit with these two tricks - (1) for kids in isolettes or radiant warmers, try to put as much as the Vapotherm tubing into the bed as possible, so it stays warm and produces less rainout, and (2) for bigger kids in cribs, set the temp at 35 degrees instead of 37, so the tubing temperature is a little closer to room air.

The other problem is that we used duoderm or coloplast/comfeel before to cushion the babies' cheeks, and tegaderm over that. Both were absorbing the condensation and getting waterlogged. So now we usually use the pink Hytape instead because it doesn't absorb water, and is actually waterproof. We put a layer down on the bare skin and then another over the cannula.

The biggest problem we've seen is that people don't always realize that it's delivering CPAP-worthy pressures and that the kids do need an OG open to gravity at all times to vent their stomachs while on Vapotherm. We've seen a lot of dilated bowel loops and false NEC scares because of this.

fergus51 · Jan 6, 2005

We were using basically the same thing in Canada for years (high flow), but it's fairly new at my hospital here in California. Like everything new, most of the nurses here don't like it, but I love it. It's so much better for their little noses than CPAP.

NICUnewbie · Jan 7, 2005

We've also been using Vapotherm for about a year and are loving it!!! The kids like it so much better than CPAP - we have the CPAP with the long nasal prongs, not the one with the cap - even though it's SO loud when its >3LPM! But the only time we use CPAP now is when we need cycled CPAP for really borderline kiddos. From 500 gram micropreemies to 5 kg chronics - we've had them all on Vapotherm with excellent results.
As for the condensation, that is definitely a problem. We've been able to decrease it a little bit with these two tricks - (1) for kids in isolettes or radiant warmers, try to put as much as the Vapotherm tubing into the bed as possible, so it stays warm and produces less rainout, and (2) for bigger kids in cribs, set the temp at 35 degrees instead of 37, so the tubing temperature is a little closer to room air.
The other problem is that we used duoderm or coloplast/comfeel before to cushion the babies' cheeks, and tegaderm over that. Both were absorbing the condensation and getting waterlogged. So now we usually use the pink Hytape instead because it doesn't absorb water, and is actually waterproof. We put a layer down on the bare skin and then another over the cannula.
The biggest problem we've seen is that people don't always realize that it's delivering CPAP-worthy pressures and that the kids do need an OG open to gravity at all times to vent their stomachs while on Vapotherm. We've seen a lot of dilated bowel loops and false NEC scares because of this.

Gompers~

Thanks for the tip about leaving the NG/OG tube open to air....solves the mystery of why my patient's little belly was becoming distended last night!! Can't wait to share your tips with my co-workers tonight!

KRVRN, BSN, RN · Jan 8, 2005

We started playing with Vapotherms several months ago and we've seen some good results also. There is a reluctance on the part of the neos to put the babies on greater than 2L though. It's a rare baby that we get up to 4L. I think they are comparing it to NC's such that above 2L flow is a lot. Shoot, we freely blow 8 or 10L at a baby's nose when we use NCPAP! The Vapotherms are meant to give high flows! I like them because I believe they are more comfortable for the baby.

Gompers, BSN, RN · Jan 8, 2005

There is a reluctance on the part of the neos to put the babies on greater than 2L though. It's a rare baby that we get up to 4L. I think they are comparing it to NC's such that above 2L flow is a lot.

Yeah, when the rep came through to inservice the staff on Vapotherm, they made sure that all the MDs and NNPs got training as well. I mean, it's not like we're giving the babies >2L straight oxygen - it's just air!!! We've had kids all the way up to 8L - anything to keep them off the vent!

Like I said, the only big problem I've seen has been distended bellies from not having their stomachs vented.

premies_4_40yrs · Jan 16, 2005

We've been using them for a while now.... the biggest problem is, we don't have enough units to go around. With an average of 50+ babies all the time, we're always trying to "rob Peter to pay Paul", so to speak. The biggest problem I've experienced is the amount of condensation near the baby's nares; and the frequency of the unit's alarm going off. Otherwise, the babies seem to thrive on the VT. So much easier on their little noses than the dreaded CPAP catheters. The secretions stay thinner too, with all the humidity.

nekhismom · Jan 16, 2005

We're not using it, and I can't imagine any of our providers actually going for it. We keep the kids vented FOREVER it seems. I haven't seen a single early extubation since I've been at this hospital. We have preemies vented on ROOM AIR, with low pressures. But since they are preemies, they can't be un-vented. :rolleyes:

I'd like to see this, though. Think I'm gonna search out their website. :)

BittyBabyGrower, MSN, RN · Jan 16, 2005

I'd like to see that in our unit too...but they are so reluctant to spend money on anything new.

kitty29 · Jan 19, 2005

We've been using a high-flow ncann system, but this sounds better...do you have a web site for the product?

TiffyRN, BSN, PhD · Jan 19, 2005

http://www.vtherm.com/

I might have mentioned I got no inservice on this product so I had to go the website to find out anything about it (that and the product booklet).