(049) Assessment of Swallowing Function While Using High-Flow Nasal Cannula

Introduction: Despite widespread use of High Flow Nasal Cannula (HFNC) for respiratory support, the effect of HFNC on swallowing physiology is poorly understood. Research to date suggests that healthy individuals may have diminished swallowing function and safety at higher flow rates; however, rates that permit safe swallowing without increased risk for aspiration have not been established and require further investigation.

Methods: Swallowing function in a cohort of pre-screened, non-dysphagic, healthy individuals was assessed using Fiberoptic Endoscopic Evaluation of Swallowing (FEES), the gold standard assessment of oropharyngeal swallowing. Participants’ safety and efficiency of swallowing was assessed with different textures under varying, randomized flow rates of HFNC (0-60 Liters/Min). FEES trials were scored by two certified speech and language pathologists using the 8-point Penetration-Aspiration Scale (PAS) and Yale Pharyngeal Residue Severity Rating Scale. PAS scores of 1-2 were considered safe, and scores of 3-8 were considered unsafe. Pearson chi-square tests were used to test for significant association between PAS result and rate of HFNC and consistency across each quantity of material.

Results: 27 healthy subjects were enrolled in the study. 41% were male (n=11), and 59% were female (n=16). Mean age was 34±11. 501 swallows (53%) out of 945 total swallows assessed were considered safe (PAS score 1-2), while 444 swallows (47%) were considered unsafe (PAS score 3-8). Initial analysis demonstrated no significant association between swallow safety and rate of HFNC using Pearson Chi-Square test across all consistencies and across all quantities of materials (P>0.05).

Conclusions: Our preliminary results here-in demonstrate that healthy individuals may safely use HFNC while eating by mouth without increasing risk of penetration or aspiration. Complete analysis will be completed. More research is needed to better understand how swallowing physiology is affected by respiratory support and what levels of respiratory support can be safely used in ill patients without increasing risk of aspiration.