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Risk of Aspiration in Patients on High-Flow Oxygen Therapy
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A5281 - Risk of Aspiration in Patients on High-Flow Oxygen Therapy
Author Block: A. Jaffe1, A. Seevaratnam2, S. Waters3; 1University of Central Florida COM - Ocala Campus, Ocala, FL, United States, 2Ocala Health, Ocala, FL, United States, 3Speech Therapy, Ocala Health, Ocala, FL, United States.
High-flow nasal cannula (HFNC) has been gaining attention over the past few years as a safe and innovative method of respiratory support for the critically ill population. Critical care physicians have been utilizing this non-invasive therapy for hypoxic respiratory failure and other varying conditions despite limited randomized clinical trials. Compared to other forms of noninvasive ventilation, HFNC allows the patient to eat and drink without having to interrupt therapy, however, there is a lack of data supporting the safety of HFNC in regards to risk of aspiration during oral intake. Here, we analyze a small case series exploring increasing flow rates for HFNC and aspiration.
Case 1: 81 year old male admitted for motor vehicle accident and closed head injury and C7 fracture requiring surgical intervention. Post-extubation, the patient was placed on HFNC. Patient underwent an initial videofluoroscopic swallow evaluation with HFNC at 55 LPM which documented gross aspiration with ineffective cough response and patient was determined unsafe for oral intake. A repeat videofluoroscopy was completed four days later with HFNC at 20 LPM which documented micro-aspiration, however, patient demonstrated an effective airway-clearing cough, resulting in patient being approved for oral intake.
Case 2: 86 year old female admitted for respiratory distress following opioid overdose. An initial videofluoroscopy was completed with HFNC in place at 30 LPM with patient demonstrating silent aspiration and deemed unsafe for oral intake. Repeat videofluoroscopy completed 3 days later with nasal cannula revealed patient with no penetration and no aspiration, and patient was cleared for oral intake of a modified diet.
This case series highlights the importance of further investigation into HFNC and its safety during oral intake. While this is a small sample size, it serves as a foundation for larger prospective trials. Ongoing studies utilizing Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and video-fluoroscopy with patients on various flow rates are warranted. Implications for current practice would include utilization of a formal speech evaluation using FEES or videofluoroscopy for all patients and repeat evaluations when making significant increases in flow rate. Physicians should pay special attention for signs of aspiration in patients on HFNC with a low threshold for further swallow investigation.
Author Block: A. Jaffe1, A. Seevaratnam2, S. Waters3; 1University of Central Florida COM - Ocala Campus, Ocala, FL, United States, 2Ocala Health, Ocala, FL, United States, 3Speech Therapy, Ocala Health, Ocala, FL, United States.
High-flow nasal cannula (HFNC) has been gaining attention over the past few years as a safe and innovative method of respiratory support for the critically ill population. Critical care physicians have been utilizing this non-invasive therapy for hypoxic respiratory failure and other varying conditions despite limited randomized clinical trials. Compared to other forms of noninvasive ventilation, HFNC allows the patient to eat and drink without having to interrupt therapy, however, there is a lack of data supporting the safety of HFNC in regards to risk of aspiration during oral intake. Here, we analyze a small case series exploring increasing flow rates for HFNC and aspiration.
Case 1: 81 year old male admitted for motor vehicle accident and closed head injury and C7 fracture requiring surgical intervention. Post-extubation, the patient was placed on HFNC. Patient underwent an initial videofluoroscopic swallow evaluation with HFNC at 55 LPM which documented gross aspiration with ineffective cough response and patient was determined unsafe for oral intake. A repeat videofluoroscopy was completed four days later with HFNC at 20 LPM which documented micro-aspiration, however, patient demonstrated an effective airway-clearing cough, resulting in patient being approved for oral intake.
Case 2: 86 year old female admitted for respiratory distress following opioid overdose. An initial videofluoroscopy was completed with HFNC in place at 30 LPM with patient demonstrating silent aspiration and deemed unsafe for oral intake. Repeat videofluoroscopy completed 3 days later with nasal cannula revealed patient with no penetration and no aspiration, and patient was cleared for oral intake of a modified diet.
This case series highlights the importance of further investigation into HFNC and its safety during oral intake. While this is a small sample size, it serves as a foundation for larger prospective trials. Ongoing studies utilizing Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and video-fluoroscopy with patients on various flow rates are warranted. Implications for current practice would include utilization of a formal speech evaluation using FEES or videofluoroscopy for all patients and repeat evaluations when making significant increases in flow rate. Physicians should pay special attention for signs of aspiration in patients on HFNC with a low threshold for further swallow investigation.
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