(1187) High-Flow Nasal Oxygen: Impact on Aspiration and the Care of Medically Complex Patients

Introduction: Identifying aspiration is an important but under-recognized component to reducing a patient’s hospital length of stay, reducing hospital costs and lessening mortality risk. Given increased utilization of High Flow Nasal Oxygen (HFNO; flow rate >10L/min) and limited evidence identifying effects of HFNO on swallowing and aspiration, more research is needed to determine any correlation between aspiration and HFNO.

Methods: We performed a prospective chart review of 1,118 adult patients receiving supplemental oxygen therapy and Speech Language Pathology (SLP) services admitted to two Phoenix area hospitals from December 2020 - October 2022. Records were reviewed for the following data points: completion of an objective swallow study, aspiration diagnosed by SLP, Penetration-Aspiration Scale (PAS) scores, demographics, and Low Flow Oxygen Therapy (LFNO) vs HFNO. Patients were considered higher risk of dysphagia-related complications when scoring >4 on PAS. Multivariable logistic regression models and descriptive statistics were utilized for data analysis.

Results: Patients who aspirate are less likely to be female (OR: .47, p=.000), have a longer length of hospitalization (OR: 1.03, p=.000), and have neurological (OR: 1.67, p=.000) or other comorbidities (OR: 1.39, p=.006). Multivariable logistic regression modeling showed that HFNO was not significantly associated with aspiration as measured by a PAS 5-8, thin liquids (OR: .73, p=.191). A significantly higher proportion of patients were found to silently aspirate at the 10-20L/min oxygen level than patients on 0-9L/min. Multivariable logistic regression modeling similarly showed that HFNO alone was not significantly associated with aspiration (PAS 5-8, thin liquids; OR: .73, p=.191).

Conclusions: The presence of HFNO alone does not correlate with aspiration events, however, HFNO therapy is associated with silent aspiration at 10-20L/min compared to LFNO. The risk of aspiration did not differ significantly past the >20L/min threshold. Although HFNO is not an independent risk factor for aspiration, clinical caution is recommended for patients with neurological comorbidities who are at higher risk of longer hospitalization with an increased risk of aspiration and mortality.