Therapy with Nasal Insufflation

A huge step in nasal high flow therapy.

TNI soft Flow 50 is the flagship of the TNI product family. It has been developedthroughintensiveresearchandfocusseddevelopmentinTherapywithNasalInsufflation(TNI).

The three pillars of TNI.

Due to the unique technology of the internal high flow generator, TNI soft Flow 50generates a precisely regulated, stable high flow (TNI Flow) from room air or a mixofroomairandoxygen.Controlledoxygensupplyensuresoxygenationwhile,atthesametime, the respiratory airways are humidified.

Convincing. The quality of life.

Inpractice,thistherapyismoreeffectivethanconventionaloxygentherapyandjustas successful but much more comfortable than NIV (non-invasive ventilation). The use of a soft, comfortable and noise-optimized patient interface ensures recovering patients’ quality of life. Being able to eat, drink and talk during therapy contributes significantly to higher patient compliance.

Wecan Flow.

A stable air flow is essential for treating hypoxemic and hypercapnic respiratory failure. Together with the TNI applicator (comprising respiratory circuit and patient interface),the TNI Flow generator guaranteesa constant TNI Flow and in doing so, it is completely independent of external pneumatic systems. Due to this, theTNIsoftFlow50isabletotreatrespiratoryinsufficiencyandallowstherapyathomeasreliable and efficient as in the hospital.

Improved respiratory efficiency

Reduction of hypercapnia

Studies with chronic hypercapnic COPD and IPF patients show that applying TNI forashorttimereducesarterialpCO2.Athigherflowrates,pCO₂decreasesevenfurther.AsignificantdecreaseinpCO₂wasnoticedinstablehypercapnicCOPDpatientswhowere treated with TNI at home for several weeks. The normocapnic value remained stable during the following NIV treatment(Bräunlichetal.,2013a,2015a,2016;Fig.1).

1pCO₂levelsofhypercapnicCOPDpatients during spontaneous breathing following TNI and NIV. * Significant pvalue.Source:Bräunlichetal.,2015a

Mechanism: Wash out effect


ThewashouteffectisviewedasthecentralmechanismofpCO₂reduction.Supplyinga flow rate exceeding the inspiratory demand results in a constant washout of breathed air(rich in CO₂) out of the nasopharynx and the small air ways. Of essential value is a stable air flow during inspiration and expiration. This is guaranteed by thetechnology of the TNI Flow generator in combination with the TNI applicator. CO₂ elimination increases with higher flowrates (Bräun lichetal., 2017,Fig.2).



Efficient oxygenation

TNIefficientlytreatschronichypoxemicrespiratoryinsufficiencywithoutcausinganyside effects. This was confirmed during a clinical comparison with conventional O₂ therapy in stable O2-dependent COPD patients. The application of TNI Flow alone(without adding O₂) already resulted in an improved oxygenation. A comparativelylower volume of O2 had to be added to the therapy air to reach the same level ofoxygenationaswithpure O2therapy(Vogelsingeret al.,2013).

Mechanism: constant Fi O₂ +PEEP


The stable high TNI Flow guarantees continuous supply of therapy air with an Fi O₂ value that is individually adjusted to the patient’s deficit. It remains stable even during high breathing frequency. As the flow rate increases, a PEEP builds up: an expiratory alveolar collapse is avoided and otherwise insufficiently ventilated areas of the lung are recruited. As a consequence, the gas exchange improves (Bräun lichetal., 2016, 2017;Fig.3; McGinley etal., 2007).

In patients suffering from chronic respiratory insufficiency, the respiratory musclesareconstantlyoverloaded.DuringTNI,thedesiredeffectofarespiratorytherapycanbenoticed:COPDpatientswerebreathingsloweranddeeper;therespiratoryminuteventilation decreased (Bräunlich et al., 2013a). The respiratory muscles were thusrelieved,restedandwere abletoresumetheir ventilatingfunctionagain.

In comparison to breathing room air or O₂, TNI facilitated work of breathing during sleep in COPD patients (Biselli et al., 2016; Fig. 4). Reaction due to an improved exchange of gas and a reduced sympathetic tone is discussed as mode of action. Sympathetic activity decreased in REM and Non-REM phases in COPD patientsduringTNI,butnotduringanO₂therapyasshowninclinicalstudies(Schneider,DGPcongress2017,Symposium”Symposium„NHF:Thebetteralternative?“).