Effects of Oxygen via High-Flow Nasal Cannula on Adult Oropharyngeal Swallowing: A Literature Review

Abstract

Purpose The use of high-flow oxygen via nasal cannula has become increasingly more common in various patient populations given the multiple benefits for treating respiratory distress and failure. There is emerging, though varying research on the impact high-flow oxygen delivery may have on adult oropharyngeal swallowing function. The purpose of this literature review is to outline available research and examine study design, populations investigated, findings, and clinical considerations of these findings. Method After an extensive online database search, we found five available peer-reviewed research articles specifically investigating oropharyngeal swallowing function in adults receiving high-flow nasal cannula (HFNC) therapy. Each article was reviewed and summarized in detail with close attention paid to results and clinical implications. Limitations, indirectness, and/or methodologic flaws are highlighted for the readers' consideration. Conclusions Four prospective design studies and one retrospective data analysis collection have been published evaluating the effects of high-flow oxygen therapy on adult oropharyngeal swallowing. Three of the prospective design studies evaluated healthy adults; one prospective design and the retrospective analysis data collection investigated acute care patients requiring HFNC. Study findings varied greatly likely due to variability of each study's subject population, design, and methods. Variability of results may make it challenging for speech pathologists attempting to use evidence-based decision making in clinical practice. Additional studies investigating nonhealthy subjects undergoing instrumental swallow studies while on HFNC are warranted.

Assessing swallowing disorders in adults on high-flow nasal cannula in critical and non-critical care settings. A scoping review protocol

“…Positive end-expiratory pressure generated in the airway by HFNC, with varying values depending on the flow used, could impair the proper swallowing performance, altering synchronization of breathing and swallowing [ 22 ]. This could be explained by the fact that during normal swallowing, the contact time phase of the vellum against the posterior pharyngeal wall is delayed.…”

“…Most of the research related to the research question posed in this protocol has focused on pediatrics, probably because the evidence supports the use of HFNC in this population [ 20 , 21 ]. Evidence synthesis studies that have considered this topic in the adult population have not focused on methods of assessment disorders and have not been conducted using a systematic methodology [ 22 , 23 ]. In addition, have limited the inclusion of studies by publication status [ 22 ], and have presented findings by summarizing studies separately rather than in an integrative analysis [ 22 ].…”

“…Evidence synthesis studies that have considered this topic in the adult population have not focused on methods of assessment disorders and have not been conducted using a systematic methodology [22,23]. In addition, have limited the inclusion of studies by publication status [22], and have presented findings by summarizing studies separately rather than in an integrative analysis [22].…”

Nutrition during noninvasive respiratory support

“…2 shows the decrease in the repetitive ability to swallow saliva with the increase in flow. This could impair proper swallowing by altering the synchrony and coordination between breathing and swallowing [25]. During normal swallowing, the contact time phase of the vellum against the posterior pharyngeal wall is delayed.…”

Impacto de la cánula nasal de alto flujo y la ventilación no invasiva en la fisiología deglutoria: revisión de la literatura

“…En este sentido, si bien es una temática poco estudiada, con pocas publicaciones y un nivel de evidencia limitado, la presente revisión constituye la base para desarrollar cuestionamientos que permitan al fonoaudiólogo clínico que se desempeña en el ámbito de la deglución, considerar otros elementos que podrían afectar el rendimiento de los usuarios con dispositivos no invasivos como la CNAF y VNI. Es importante mencionar que, a la fecha de desarrollo de este manuscrito, se encontró una revisión similar (Devlin & O'Bryan, 2021) enfocada sólo en sujetos con CNAF. La metodología empleada en dicha revisión difiere de la planteada en este manuscrito, pues los estudios sólo fueron analizados en forma individual con sus resultados y limitaciones; sin extrapolar ni analizar la información en forma global como aquí se presenta.…”