title: Oral Alimentation in Neonatal and Adult Populations Requiring High-Flow Oxygen via Nasal Cannula.
abstract: Use of high-flow oxygen via nasal cannula (HFO2-NC) is increasingly common in intensive care unit (ICU) settings. Despite the critical interface between respiration and swallowing, and the high acuity of patients in ICUs, the impact of HFO2-NC on feeding and swallowing is unknown. The present prospective, single-center, cohort study investigated the impact of HFO2-NC use on oral alimentation in neonatal and adult ICU patients. Oral alimentation status was evaluated in 100 consecutive ICU inpatients (50 neonatal and 50 adult) requiring HFO2-NC. Participant characteristics, respiratory support, successful initiation of oral feeding in neonates, and successful resumption of oral feeding in adults were recorded. Seventeen of 50 (34 %) neonates requiring HFO2-NC were deemed developmentally and medically appropriate by the neonatologist and nursing to begin oral alimentation. All 17 (100 %) were successful with initiation of oral feedings. Thirty-three of 50 (66 %) continued nil per os due to prematurity or medical conditions precluding oral alimentation at time of data collection. Thirty-nine of 50 (78 %) adults requiring HFO2-NC were deemed medically appropriate by the intensivist and nursing to resume oral alimentation (n = 34) or with a functional swallow without aspiration on FEES (n = 5). All 39 (100 %) resumed oral alimentation successfully. Eleven of 50 (22 %) continued nil per os due to severe respiratory issues precluding both swallow testing and oral alimentation at time of data collection. All developmentally and medically appropriate neonatal and adult patients requiring HFO2-NC were successful with either the introduction or resumption of oral alimentation. Patients requiring HFO2-NC who are identified as having feeding or swallowing issues should be referred for swallowing evaluations using the same criteria as patients who do not require HFO2-NC, as it is not the use of HFO2-NC but rather patient-specific determinants of feeding and swallowing readiness and their underlying medical conditions that impact readiness for oral alimentation status.
authors.affiliation: Department of Surgery, Section of Otolaryngology, Yale School of Medicine, P.O. Box 208041, New Haven, CT, 06520-8041, USA. steven.leder@yale.edu.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Leder
authors.affiliation: Department of Pulmonary and Critical Care, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Siner
authors.affiliation: Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bizzarro
authors.affiliation: Division of Pediatric Pulmonary and Sleep Medicine, University of Utah, Salt Lake City, UT, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: McGinley
authors.affiliation: Departments of Pediatrics, Otolaryngology-Head and Neck Surgery, and Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Lefton-Greif
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072601:Cannula / Q000009:adverse effects*; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000209:etiology* / Q000503:physiopathology; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects* / Q000295:instrumentation; D011446:Prospective Studies
keywords: Deglutition; Deglutition disorders; Geriatrics; High-flow oxygen via nasal cannula; Neonatal; Non-invasive ventilation