By Angie Marcos
This month’s Market Analysis Q&A asked executives from two companies manufacturing products for use in high flow humidification therapy about their most recent products, key trends in the humidification industry, and the development of more affordable, easier to use humidification technology. Executives additionally addressed rising health care costs and how manufacturers are helping health care providers adopt new advanced technologies that ensure a meaningful return on their investment.
Our respondents include Jeri Eiserman, RRT, director of clinical support, Teleflex Medical, Durham, NC; and Kevin Thibodeau, vice president of marketing, clinical, and international sales, Vapotherm Inc, Stevensville, Md.
RT: What are the latest technological trends in humidified high flow therapy that are key to meeting the needs of RTs?
Eiserman: The availability of heated, humidified high flow nasal cannula systems offers the respiratory clinician a viable option for addressing hypoxemic respiratory compromise or failure in a noninvasive manner that is comfortable, well tolerated, and effective in patients of all ages. The prudent use of these products may help avoid the need for invasive or complex interventions (ie, noninvasive ventilation, NCPAP, intubation, and ventilation) and can be a useful adjunct in weaning patients from more invasive forms of therapy.
Thibodeau: RTs, like so many others in the health care system, are being asked to do more with less. It is essential the devices they use are easy to set up and operate, as well as limit the number of times they need to check on the system and patient interface. RTs also are looking for ways to deliver efficient respiratory care while improving patient satisfaction. Technological advances in humidification technology mean RTs can provide a high level of respiratory support by exceeding their patient’s inspiratory demands. This can be accomplished by improving oxygenation and ventilation while maintaining maximum patient comfort. Engineering allows systems like the Vapotherm to deliver gases at body temperature through a simple nasal cannula. The RT is able to offer the patient a high level of respiratory support without the downsides of mask and pressure therapies. Finally, electronic flow control and blending systems mean RTs can now use a single integrated device to control temperature, flow rates, and Fio2 rather than cobble together multiple devices.
RT: Tell us about your company’s most recent products for use in humidified high flow therapy and why they are innovative?
Eiserman: Teleflex, under the Hudson RCI brand, offers the Comfort-Flo® High Flow Nasal Cannula System,used in conjunction with the ConchaTherm® Neptune® Heated Humidifier. This system allows for the safe and effective delivery of heated, humidified oxygen therapy to a broad range of patients, from premature infants to adults. The Comfort-Flo cannulas are available in four sizes and, along with the heated-wire circuit, allow for flow rates from 1 to 40 LPM. ConchaTherm Neptune’s adjustable airway temperature and gradient distinguish it from other humidifiers in the marketplace; and allow for customization of therapy to address the needs of the individual patient, enhance patient comfort, and minimize condensation.
Teleflex also offers the Hudson RCI Softech® Advanced Comfort Fit™ High Flow Cannula. The unique design characteristics of this cannula allow for flows of up to 15 LPM, without the accompanying high back pressures that are encountered with standard cannulas. When used with the AQUA-PAK® prefilled humidifiers, the clinician is able to provide humidified oxygen therapy to adult patients who require higher levels of oxygen than can be provided by conventional nasal cannulas. The Advanced Comfort Fit High Flow Cannulas feature ear cushions that help to relieve pressure over the ears, often a source of pain and skin breakdown, thus promoting comfort and enhancing the quality of care. They are available with either 7 feet or 14 feet of Hudson RCI Star Lumen® oxygen tubing that resists kinking; and incorporate a universal connector for easy connection to any oxygen source.
Thibodeau: Our major platform product is the Precision Flow, which is the only fully integrated high flow humidification device for conditioning breathing gases including air, oxygen, heliox, and nitric oxide. The technology is anchored by two core technologies: the vapor transfer cartridge, which creates the high vapor phase humidity, and the patient delivery circuit, which has a patented triple lumen water jacketed design to maintain the humidity all the way to the patient. The device also has integrated flow and Fio2 control and the most comprehensive alarms and indicators for patient safety and ease of use.
RT: What key trend do you think will carry the development of high flow-related humidification technology forward in the next 5 years?
Eiserman: The continuing desire to support oxygenation, while avoiding more expensive, complex and invasive therapies, and the need to do it safely and comfortably will stimulate increasing use of high flow humidification technology, like that provided by heated, humidified high flow nasal cannula therapy, as well as high flow cannulas that allow for the delivery of higher flows of oxygen than can be delivered by standard cannulas. Additionally, as more randomized, controlled studies are carried out to identify and determine the impact of these therapies on patient outcomes, it is likely that their use will increase.
Thibodeau: There are three major trends that will propel high flow. First, respiratory diseases, both chronic and acute, are increasing, driven by the aging population and environmental factors. Second, the patient experience in health care matters. Comfort is no longer just nice to have, so a technology that lets a patient eat, drink, and talk while receiving therapy stands out over other respiratory modalities. And third, accountable care is here to stay. Hospitals need to improve the efficiency of care and reduce costs associated with more invasive or intrusive therapies.
RT: Given the rising costs of health care and the tighter budgets health care facilities are forced to work with, how are manufacturers helping health care providers adopt new advanced technologies and ensuring that there is a meaningful return on their investment?
Eiserman: As a manufacturer, Teleflex endeavors to offer health care providers with cost-effective, versatile products that provide a variety of therapies. For instance, the ConchaTherm Neptune Heated Humidifier can be used to provide humidification across the patient care spectrum. Because of its adjustability, it can be used in any patient scenario where heated humidification is needed—with heated, humidified nasal cannula therapy, noninvasive ventilation, invasive ventilation, infant nasal CPAP, and heated aerosol therapy. ConchaTherm Neptune offers one humidification system for multiple therapeutic applications and also meets the recommendations and key points outlined in the AARC Clinical Practice Guideline for Humidification During Invasive and Non-Invasive Ventilation, May 2012. This is just one example of our mission to provide products that help minimize length of stay, maximize patient and caregiver safety, and optimize patient workflow.
Thibodeau: Manufacturers need to provide hospitals with significant financial breakthroughs to address the key economic drivers for hospitals related to the Affordable Care Act. As hospitals face penalties for readmissions, never events, and other impacts to reimbursement, therapies should be aligned with accountable care. High flow therapy provides hospitals with a tool that reduces the iatrogenic impact of other respiratory therapiesincluding intubations, which can result in increased length of stay, VAP (ventilator-associated pneumonia), and other major costs. Additionally, mask therapies can result in HAPUs (hospital acquired pressure ulcers) and other patient issues, costly never events for hospitals. High flow also offers hospitals a therapy that is easier to use, saving time and lowering the intensity of care. Finally, use of high flow in environments outside the ICU, including the ER and the home, can help reduce admissions and the revolving door that is so common in the most costly chronic respiratory diseases like COPD. On the revenue side, high flow provides hospitals with a way to increase patient satisfaction, which not only affects third party scores, but also referrals and repeat business. In other words, quality of care now means both good outcomes but also a good “customer” experience.
RT: What markets or health care settings exhibit the best opportunity for growth in humidification product sales?
Eiserman: Humidification products have applications across the spectrum of care, regardless of the care setting. Whether in home care, acute in-hospital care, long-term acute care facilities, or hospice care, the provision of adequate humidity, in concert with the other respiratory modalities being utilized, is very important. The goal of manufacturers should be to provide products that can be utilized safely and economically to provide for the unique needs of the patient populations in all possible care sites. If we are able to do that successfully, there are opportunities for growth in all health care settings.
Thibodeau: While high flow has strong opportunity throughout the health care delivery system, we see the most interesting growth segments in the ER and home environments. Long-term care also should grow significantly, and as acute care hospitals look for less invasive, cost-effective technologies, intensive care, and general floor use also will prosper.
Angie Marcos is associate editor for RT. For further information, contact [email protected].