VAPOTHERM Pocket Guide Rev A

Patient Selection

Diagnoses

Signs and Symptoms: Patient presents with one or more of the following:

These conditions may benefit from Vapotherm:

• Mild to moderate respiratory distress • Hypoxemia • Hypercapnia • Tachypnea • Accessory muscle use • Grunting • Nasal flaring • Mild apnea and bradycardia (neonate)

• Acute Respiratory Distress Syndrome (ARDS) • Viral bronchiolitis • Pneumonia • Severe Acute Asthma • Congenital Heart Defects (CHD) • Persistent Pulmonary Hypertension • Bronchopulmonary Displasia (BPD) • Separation from mechanical ventilation • Separation from non-invasive ventilation

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Vapotherm PICU Pocket Guide

Vapotherm Cannula & Flow Selection FITTING THE CANNULA: • Make sure not to occlude greater than 50% of the internal diameter of each of the nares. • Cannula prongs should be wide enough not to “pinch” the nasal septum (erosion risk). • The SOLO cannula is a single prong cannula that can be used in neonates and infants. The single prong design ensures less than 50% nostril occlusion, and is as effective as a dual prong cannula. The single prong also allows for placement of a NG tube. Cannula Sizes

Cannula Flow Range

Tip OD

Premature

1-8 L/min

1.5 mm

Neonatal

1-8 L/min

1.5 mm

SOLO (single prong)

1-8 L/min

1.9 mm

Infant

1-8 L/min

1.9 mm

Intermediate Infant

1-8 L/min

1.9 mm

Pediatric Small

1-20 L/min

1.9 mm

Pediatric/Adult Small

5-40 L/min

2.7 mm

Adult

5-40 L/min

4.8 mm

Cannula(s)

Typical Starting Flow

FLOW SELECTION: Age

Weight

0 – 30 days

<4kg

4-5 L/min

1 mo – 1 year

4-10kg

5-8 L/min

1 – 6 years

10-20kg

5-10 L/min

6 – 12 years

20-40kg

10-14 L/min

12 – 18 years

>40kg

12-16 L/min

Disclaimer: Suggested flow rates and FiO2 settings are guidelines. Actual settings should be determined according to specific patient requirements and physician discretion.

CANNULA APPLICATION: • Only Vapotherm cannulae should be used with the Vapotherm Precision Flow • Select the appropriate cannula based on the above sizing chart • Place the cannula on the patient before attaching the delivery tube • Allow the system to reach the set point before connecting delivery tube to the cannula • The Precision Flow’s operational flow range is locked depending on the disposable patient circuit (DPC) selected: – High Flow DPC (Blue packaging): 5-40 L/min – Low Flow DPC (Red packaging): 1-8 L/min

Vapotherm PICU Pocket Guide

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Therapy Implementation and Maintenance

0 – 30 days

Start flow at 5 L/min and increase by 1 L/min, as WOB requires

1 mo – 1 year

Start flow at 6 L/min and increase by 1 L/min, as WOB requires

1 – 6 years

Start flow at 8 L/min and increase by 1L/min, as WOB requires

6 – 12 years

Start flow at 10 L/min and increase by 1-2 L/min, as WOB requires

12 – 18 years

PATIENT ASSESMENT: SpO2<92% and/or increased work of breathing (WOB)*

Start flow at 12 L/min and increase by 2 L/min, as WOB requires

Set temperature to 36-37°C

Set temperature to 37°C and decrease per patient preference

Start FiO2 at 0.40 and titrate, as needed to achieve target SpO2 SpO2 >92% same as above except start FiO2 at 0.21

Start at 0.60 and titrate, as needed to achieve target SpO2 SpO2 >92% same as above except start FiO2 at 0.21

*Management of patients with cyanotic congenital heart disease should target disease-specific SpO2 targets. Suggested starting FiO2 guidelines do not apply to patients with single ventricle physiology undergoing palliation, or patients adversely affected by oxygen-mediated decreases in pulmonary vascular resistance.

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Vapotherm PICU Pocket Guide

Monitoring Therapy

Patient Parameters:

Documentation:

• Indices of work of breathing (WOB)

Patient

• SpO2

• Respiratory rate

• PCO2 • FiO2 • Nasopharynx patency • Feeding tolerance

• Heart rate • Work of breathing (WOB) • SpO2 Device • Flow rate • FiO2 • Temperature • Water level • Cannula size

Vapotherm PICU Pocket Guide

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Vapotherm Weaning

0 – 30 days

If FiO2 ≤ .60, flow rate may be weaned by 1-2 L/min every hour

1 mo – 1 year

If FiO2 ≤ .60, flow rate may be weaned by 1-2 L/min every hour

1 – 6 years

If FiO2 ≤ .60, flow rate may be weaned by 1-2 L/min every hour

6 – 12 years

If FiO2 ≤ .60, flow rate may be weaned by 1-2 L/min every hour

12 – 18 years

PATIENT ASSESMENT: SpO2 >93% or within desired range and unlabored respirations

If FiO2 ≤ .60, flow rate may be weaned by 1-4 L/min every hour

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Vapotherm PICU Pocket Guide

Wean FiO2 by decreasing 2-5% every 30-60 minutes

Set temperature to 36- 37°C or to patient preference

Wean FiO2 by decreasing 5-10% every hour

Accessories USE WITH AEROGEN® • An adapter is available for the Precision Flow to enable nebulizer treatments. The inline adapter is designed to be used specifically with the Aerogen® Aeroneb® solo (AAA-1). • The adapter is not for continuous use and should be removed after each treatment. • It is important to maintain proper upright orientation of the inline adapter during the drug administration process. Vapotherm recommends the AAA-1 be at an upright 45º angle to minimize condensation. USE WITH NITRIC OXIDE • Vapotherm technology is verified for use with INOmax® DS and DSIR (PF-NODPC-LOW 1-8 L/min, PF-NODPC-HIGH 5-40 L/min). • Note: See Ikaria® for instructions for use. USE WITH PRECISION FLOW HELIOX® • Vapotherm offers an ideal solution for convenient delivery of conditioned helium-oxygen gas mixtures (Heliox). • Heliox has a significantly lower density than typical air/oxygen mixtures. • The lower gas density reduces the work of breathing by reducing the force needed to move gas through the airways. • Heliox is commonly used on patients with diseases of increased airway resistance, such as bronchiolitis, asthma, post-extubation stridor, airway compression, intra and extrathoracic airway obstruction. • Precision Flow Heliox strategies follow the same general clinical guidelines for air-oxygen mixtures, except FiO2 should be titrated between 0.21 and 0.4 since higher oxygen concentrations (and lower helium concentrations) would result in a less significant clinical effect. • Vapotherm Heliox Disposable Patient Circuits (DPC) PFH-DPC-LOW 1-8 L/min PFH-DPC-HIGH 5-40 L/min Vapotherm PICU Pocket Guide

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