Evaluation of Swallow Function on Healthy Adults While Using High-Flow Nasal Cannula

Abstract

Purpose High-flow nasal cannula (HFNC) therapy is used increasingly in critically ill populations under respiratory distress. The interface between respiration and swallowing begs a better understanding of the effects of HFNC on swallow function. The current prospective cohort study investigated the effect of HFNC on swallow physiology in healthy adults. Method Eighty adults aged 35–65 years underwent modified barium swallow studies under varying flow rates of HFNC (0, 20, 40, and 60 liters per minute [lpm]). Modified barium swallow studies were scored by a blinded speech-language pathologist for 17 components of swallow function as defined by the Modified Barium Swallow Impairment Profile (MBSImP) and severity of penetration and aspiration as defined by the 8-point Penetration-Aspiration Scale ( Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996 ). Results Total MBSImP scores were statistically significantly higher at the highest flow rate (60 lpm) than those at any other flow rate. MBSImP components 1 (lip closure), 2 (tongue control during oral bolus hold), and 5 (oral residue) demonstrated statistical relevance to various flow rates. MBSImP components 12 (pharyngeal stripping wave) and 15 (tongue base retraction) were significant to age group. The 8-Point Penetration-Aspiration Scale scores were not significantly associated with flow rate nor age group. Conclusion The current study demonstrated that oral swallowing changes occur in healthy adults wearing HFNC at a high-flow rate (60 lpm). We postulate that healthy adults are able to compensate for swallowing changes while wearing HFNC; we suggest that cognition is a critical factor when evaluating patient populations for safe initiation of oral alimentation.