The use of high flow nasal cannula (HFNC) oxygen therapy is common in patients with respiratory distress to prevent intubation or ensure successful extubation. However, these critical patients also need medical nutritional support and practitioners are often reluctant to prescribe oral or enteral feeding, leading to a decrease in energy and protein intake. Vomiting and aspiration are the major concerns. A new technology detecting the presence and duration of gastro-esophageal reflux and preventing aspiration in real-time has been developed and our case shows how HFNC oxygen therapy exposes patients to significantly more reflux events as compared to mechanical ventilation. This is the first description of this technique observed in critical care.

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