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.