When a loved one needs support with their breathing, the array of machines and tubes can be intimidating. Understanding the purpose of this equipment can help alleviate some of the stress associated with the situation. Optiflow and Vapotherm are two common brand names for a type of respiratory support called high-flow nasal cannula therapy. Both systems are designed to make breathing more comfortable and effective for patients with a variety of medical conditions.
The Role of High-Flow Nasal Cannula Therapy
High-flow nasal cannula (HFNC) therapy is a non-invasive respiratory support that delivers a high flow of a blended air and oxygen mixture to a patient. The primary goal is to provide a consistent concentration of oxygen, which is useful for patients who need more support than a standard nasal cannula can offer. The system delivers precise oxygen concentrations at flow rates up to 60 liters per minute (LPM), helping to meet the patient’s full inspiratory demand.
A defining feature of HFNC therapy is the conditioning of the gas mixture. Before the air reaches the patient, it is warmed and humidified to mimic the natural balance of temperature and humidity in healthy lungs. This conditioning is important for patient comfort and tolerance, especially at high flow rates. Without it, high volumes of dry, cool air would be uncomfortable and could dry out the airways.
The therapy also works by “washing out” the carbon dioxide that accumulates in the upper airways after exhalation. This anatomical dead space is flushed with oxygen-rich air, meaning the patient inhales more fresh oxygen with the next breath. This mechanism improves gas exchange, reduces the work of breathing, and provides a small amount of positive pressure to help keep the airways open.
Key Technological Distinctions
The primary difference between the Optiflow and Vapotherm systems is how they humidify the air. Optiflow, manufactured by Fisher & Paykel, utilizes a heated pass-over humidifier. In this setup, the air-oxygen blend flows over the surface of heated water in a single-use chamber, picking up moisture before traveling through a heated tube to the patient.
Vapotherm employs a patented technology for humidification. Its system passes water through a membrane cartridge containing a bundle of hollow fibers. This process generates water vapor at a molecular level, saturating the gas stream. This method delivers a high velocity of gas, which is effective at flushing carbon dioxide from the upper airway, a process known as dead space washout.
The design of the patient interface also shows some variation. Fisher & Paykel’s Optiflow cannulas feature soft nasal prongs held in place by an elastic head strap. The system includes a larger diameter, flexible tube that connects to the prongs, with its weight supported by a lanyard worn around the neck to enhance comfort. Vapotherm also offers a range of cannula sizes designed for a comfortable and secure fit.
Use in Different Medical Scenarios
High-flow therapy is a versatile tool used across hospital settings, from the emergency department to general medical floors. It is frequently employed to treat patients with acute respiratory failure from conditions like pneumonia and COVID-19. The therapy also supports patients with exacerbations of chronic obstructive pulmonary disease (COPD) or those needing breathing assistance after removal from a mechanical ventilator.
The choice between the two systems often comes down to institutional availability, clinician familiarity, and specific patient needs. For example, Vapotherm has a long history of use in neonatal and pediatric populations. Research indicates that both Optiflow and Vapotherm are effective and safe for weaning premature infants from other forms of breathing support.
There is no universal consensus that one device is superior to the other across all scenarios. A physician might prefer the specific velocity characteristics of the Vapotherm system for a patient retaining high levels of carbon dioxide. Conversely, a respiratory therapist might be more accustomed to the interface and controls of the Optiflow device.
Comparing the Patient Experience
From the patient’s perspective, both systems are considered more comfortable than other non-invasive support, such as tight-fitting masks. A significant part of this comfort comes from the nasal interface, which sits just inside the nostrils. These components are made from soft, pliable silicone to minimize irritation during prolonged use.
The primary sensation a patient feels is a gentle, continuous flow of warm, moist air. This contrasts with standard low-flow oxygen because the temperature and humidity are controlled to ensure the therapy is well-tolerated and prevents the airways from drying out. Both systems are designed to be relatively quiet, though the main unit that generates the airflow produces a low hum.
The fit of the nasal cannula is an important factor, and both companies offer various sizes to accommodate different facial structures, from neonates to adults. The goal is a secure, effective seal without causing undue pressure or discomfort on the nose or upper lip. The design aims to allow the patient to talk, eat, and drink while receiving support.