High-flow nasal cannula oxygen therapy was effective for dysphagia associated with respiratory muscle paralysis due to cervical spinal cord injury: A case report

A Survey of Feeding Practices During High-Flow Nasal Cannula Oxygen Therapy

BACKGROUND

High-flow nasal cannula (HFNC) oxygen therapy is used to deliver warm and humidified gases to patients in respiratory failure. A purported advantage of HFNC oxygen therapy is that it can allow for oral feeding while on the device, although few data support this practice. The purpose of this study was to identify practices and opinions with regard to feeding practices during HFNC oxygen therapy.

METHODS

A survey related to the practice and opinions of feeding practices during HFNC oxygen therapy was developed and sent to respiratory therapists, speech-language pathologists, physicians, advanced practice providers, and registered dietitians.

RESULTS

Respondents included 307 professionals from 14 different countries. Most respondents worked in an academic/teaching hospital (n = 174 [56.7%]) with patients ages ≥ 18 years (n = 282 [91.9%]). Most respondents stated that their institution did not have a specific feeding protocol for HFNC oxygen therapy (n = 246 [80.4%]) and felt that patients could have an oral diet during HFNC oxygen therapy if not in imminent danger of being intubated (n = 264 [86.3%]). Fewer than half of the respondents felt that patients should have a bedside/clinical swallow examination before eating and/or drinking during HFNC oxygen therapy (n = 143 [46.7%]). By profession, most physicians/advanced practice providers (n = 67 [59.3%]), respiratory therapists (n = 37 [62.7%]) and half of the registered dietitians (n = 16 [50%]) felt that bedside/clinical swallow examinations were unnecessary before eating and/or drinking with HFNC, but speech-language pathologists were in favor (n = 77 [75.5%]).

CONCLUSIONS

Most facilities did not have a protocol to guide feeding practices when HFNC oxygen therapy is used. Most clinicians felt that an oral diet is safe for stable patients not in danger of being intubated. In general, speech-language pathologists felt that patients on HFNC oxygen therapy should undergo a bedside/clinical swallow examination before eating and/or drinking.

Use of high-flow nasal oxygen in spontaneously breathing pediatric patients undergoing tubeless airway surgery: A prospective observational study

The use of high-flow nasal oxygen is gaining popularity in apneic and spontaneously breathing adult patients during anesthesia. This prospective observational study evaluated the effect of high-flow nasal oxygen in maintaining adequate oxygenation and ventilation in spontaneously breathing pediatric patients with dynamic airway obstruction, undergoing tubeless airway surgery. Oxygenation was provided via an age-appropriate, high-flow nasal cannula at a flow rate of 2 L kg-1 min-1. Propofol and remifentanil were used to maintain anesthesia while preserving spontaneous respiration. We sought to determine the incidence and risk factors of rescue ventilation. Rescue ventilation with a face mask was performed when the pulse oximetry oxygen saturation was <90% or transcutaneous carbon dioxide was >80 mm Hg. In total, 27 patients were included in the final analysis. Median (interquartile range) of pulse oximetry and transcutaneous carbon dioxide were 100% (99%-100%) and 58.4 mm Hg (51.4-70.3 mm Hg), respectively. Altogether, 9 (33.3%) patients needed rescue ventilation during anesthesia. Of these, 7 patients (25.9%) developed oxygen desaturation (<90%) and 2 patients (7.4%) developed hypercarbia. Patients who required rescue ventilation were significantly younger (8.2 vs 28.8 months, P = .02) and required a longer anesthesia time (55.7 vs 41.0 minutes, P = .04) than those who did not. In conclusion, High-flow nasal oxygen is an alternative technique to maintain oxygenation in children undergoing airway surgeries. However, younger age and longer anesthesia time are significant risk factors leading to the requirement of rescue ventilation in these patients. Further studies with large sample size are required for clinical application of these techniques.

High Flow Nasal Cannula Decreased Pulmonary Complications in Neurologically Critically Ill Patients

Objective: Pulmonary complications could badly affect the recovery of neurological function and neurological prognosis of neurological critically ill patients. This study evaluated the effect of high-flow nasal cannula (HFNC) therapy on decreasing pulmonary complications in neurologically critically ill patients.

Patients and Methods: The patients admitted to the intensive care unit (ICU) with serious neurological disease and receiving oxygen therapy were retrospectively reviewed (Ethical No. IRB2021-YX-001). Patients were divided into the HFNC group and the conventional oxygen therapy (COT) group. We analyzed the data within these two groups, including patients’ baseline data, short-term outcomes of respiratory complications, general outcomes including hospital stay, ICU stay and mortality, and neurological functions. To analyze the relevant factors, we performed multivariable logistic regression analysis.

Results: A total of 283 patients met the criteria, including 164 cases in the HFNC group and 119 cases in the COT group. The HFNC group had remarkably less mechanical ventilation requirement with lower phlegm viscosity. Even more, ICU stay and total hospital stay were significantly shortened in the HNFC group.

Conclusion: HFNC decreased pulmonary complications in neurologically critically ill patients and improved recovery of neurological function and neurological prognosis.