PURPOSE: Few non-invasive oxygen delivery options exist for non-intubated burn patients with high oxygen requirements because nasal or mask devices are often not practical in patients with facial burns. Vapotherm 2000i (Vapotherm Inc, Stevensville, MD) is a novel oxygen delivery system that delivers vapor at 100% relative humidity near body temperature permitting flows of up to 40 liters per minute via nasal cannula. We assessed the ability of this device to improve oxygenation in patients with facial burns.
METHODS: We performed an analysis of thirteen consecutive non-intubated patients with high oxygen requirements in a single Burn Intensive Care Unit. Eight patients were on various methods of oxygen delivery to include non-rebreather face mask, face tent, or nasal cannula, five of whom had recently been extubated, prior to switching to Vapotherm. Five intubated patients undergoing a continuous positive airway pressure (CPAP) trial were extubated directly to the device. The effects of Vapotherm on oxygenation measured by PaO2/FiO2 ratio were assessed. Ventilation and respiratory rates were also compared before and after the device.
RESULTS: Oxygen delivery via nasal cannula at an average flow of 25+/−7 liters per minute significantly increased PaO2/FiO2 ratios from 182+/−78 to 270+/−90 (p=0.013). PaCO2 was also significantly decreased in the Vapotherm group. (40+/12 mmHg vs 36+/−8 mmHg, p=0.02) There was no detectable difference in respiratory rate. (32+/−9 breaths per minute vs 25+/−5 breaths per minute, p=0.47) Of the 10/13 recently extubated patients, one needed to be re-intubated within 48 hours.
CONCLUSION: The Vapotherm oxygen delivery system helps augment ventilation and oxygenation in patients with a high oxygen requirement. It is likely that delivery of positive airway pressure applied via nasal cannula explains this significant improvement.
CLINICAL IMPLICATIONS: A device with the ability to deliver up to 100% FiO2 at up to 40 liters a minute via a nasal cannula is a valuable asset in the management of burn patients with high oxygen requirements. Prospective studies are needed to determine if the device can decrease re-intubation rates.
DISCLOSURE: Kevin Chung, None.