WIP 72 - Evaluating the Risk of Aspiration with Oral Feeding on High-Flow Nasal Cannula

Publication Number: WIP 72.7466

Varun Katamaneni, Oklahoma Childrens Hospital at OU Health, Oklahoma City, OK, United States; Ahmed Arshad, Oklahoma Childrens Hospital at OU Health, Edmond, OK, United States

Background: High-flow nasal cannula (HFNC) is a common respiratory support used for children in respiratory failure. While enteral nutrition has been shown to improve patient outcomes, the practice of oral feeding on HFNC varies between clinicians. This is in part due to the lack of evidence on the safety of oral feeding with HFNC; the primary concern being aspiration. With this research we hope to evaluate the safety of oral feeding during the use of HFNC.

Objective: We hope to provide clinicians with evidence to assist in bedside-decision making on feeding. Therefore, our aim is to determine the risk of aspiration with oral feeding while receiving HFNC.

Design/Methods: We performed a single-center, retrospective chart review at a tertiary care, free-standing children’s hospital. We included patient admissions from January 2021 to May 2023. Patient were selected by screening for children under 2 years that were admitted with a primary diagnosis of acute respiratory failure with hypoxia, bronchiolitis, or pneumonia and had HFNC ordered during their admission. HFNC is defined as respiratory support with a high-flow cannula that was warmed, humidified, and at a rate > 4 liters per minute. These patients were then categorized into two groups: those that were fed orally and another with those that were made nil per os (NPO). Patients were excluded if they had chronic conditions including cardiac disease, neuromuscular disease, craniofacial abnormalities, genetic syndromes, gastrostomy tube dependence, and chronic lung disease. Demographics and outcome measures were compared between the two groups with standard t-tests. The primary outcome was adverse aspiration events defined as a subsequent diagnosis of aspiration pneumonia or the appearance of “aspiration” or “choking” in the clinical documentation after initiation of oral feeding. We also looked at secondary outcomes including length of stay, time on respiratory support, and escalation of care requiring ICU admission. The study has IRB approval. Data collection will be completed by December 2024 and analysis completed by February 2025.