A Survey of Feeding Practices With the Use of High Flow Nasal Cannula Oxygen Therapy

Abstract

Background:

High-flow nasal cannula (HFNC) oxygen therapy is used to deliver warm and humidified gases to patients in hypoxemic and hypercapnic respiratory failure. A potential benefit of HFNC oxygen therapy when compared to noninvasive ventilation, is patient comfort and tolerance of the modality. A purported advantage of HFNC oxygen therapy is that it allows for oral feeding while on the device, although little data supports this practice. The purpose of this study was to identify current practices and opinions regarding feeding practices during HFNC oxygen therapy.

Methods:

A survey related to the practices and opinions of feeding during HFNC oxygen therapy was developed and sent to respiratory therapists (RTs), speech-language pathologists (SLPs), physicians, advanced practice providers (APPs), and registered dietitians (RDs) via communication channels of their respective professional associations. The survey was open for at least 30 continuous days, and reminder emails were sent at the discretion of the associations. IRB approval was obtained.

Results:

Respondents included 307 professionals from 14 different countries. The most common respondent age range was 36-45 (n = 102, 33.2%), with the majority having 16 or more years of experience practicing (n = 128, 41.7%). Most respondents worked in an academic/teaching hospital (n = 174, 56.7%) with patients aged 18 years or older (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 patients could have an oral diet during HFNC oxygen therapy if not in imminent danger of being intubated (n = 264, 86.3%). The majority of respondents felt patients should have a bedside/clinical swallow exam before eating/drinking during HFNC oxygen therapy (n = 143, 46.7%). By profession, most physicians/APPs, RTs, and RDs felt that bedside/clinical swallow exams were unnecessary before eating/drinking with HFNC, but SLPs were in favor (n = 77, 75.5%).

Conclusions:

Most facilities do not have a protocol to guide feeding practices when HFNC oxygen therapy is used. Most providers feel an oral diet is safe for stable patients not in danger of being intubated. In general, SLPs feel patients on HFNC oxygen therapy should undergo a bedside/clinical swallow exam prior to eating/drinking.