No AccessSIG 13 Swallowing and Swallowing Disorders (Dysphagia)Research Article26 Dec 2019

Evaluation of Swallow Function on Healthy Adults While Using High-Flow Nasal Cannula


    High-flow nasal cannula (HFNC) therapy is used increasingly in critically ill populations under respiratory distress. The interface between respiration and swallowing begs a better understanding of the effects of HFNC on swallow function. The current prospective cohort study investigated the effect of HFNC on swallow physiology in healthy adults.


    Eighty adults aged 35–65 years underwent modified barium swallow studies under varying flow rates of HFNC (0, 20, 40, and 60 liters per minute [lpm]). Modified barium swallow studies were scored by a blinded speech-language pathologist for 17 components of swallow function as defined by the Modified Barium Swallow Impairment Profile (MBSImP) and severity of penetration and aspiration as defined by the 8-point Penetration-Aspiration Scale (Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996).


    Total MBSImP scores were statistically significantly higher at the highest flow rate (60 lpm) than those at any other flow rate. MBSImP components 1 (lip closure), 2 (tongue control during oral bolus hold), and 5 (oral residue) demonstrated statistical relevance to various flow rates. MBSImP components 12 (pharyngeal stripping wave) and 15 (tongue base retraction) were significant to age group. The 8-Point Penetration-Aspiration Scale scores were not significantly associated with flow rate nor age group.


    The current study demonstrated that oral swallowing changes occur in healthy adults wearing HFNC at a high-flow rate (60 lpm). We postulate that healthy adults are able to compensate for swallowing changes while wearing HFNC; we suggest that cognition is a critical factor when evaluating patient populations for safe initiation of oral alimentation.


    • Addington, W. R., Stephens, R. E., & Gilliland, K. A. (1999). Assessing the laryngeal cough reflex and the risk of developing pneumonia after stroke.Stroke, 30(6), 1203–1207.
    • Agresti, A. (2002). Categorical data analysis. Hoboken, NJ: Wiley.
    • Bonilha, H. S., Blair, J., Carnes, B., Huda, W., Humphries, K., McGrattan, K., … Martin-Harris, B. (2013). Preliminary investigation of the effect of pulse rate on judgments of swallowing impairment and treatment recommendations.Dysphagia, 28(4), 528–538.
    • Brodsky, M. B., McFarland, D. H., Michel, Y., Orr, S. B., & Martin-Harris, B. (2012). Significance of nonrespiratory airflow during swallowing.Dysphagia, 27(2), 178–184.
    • Brodsky, M. B., McNeil, M. R., Martin-Harris, B., Palmer, C. V., Grayhack, J. P., & Abbott, K. V. (2012). Effects of divided attention on swallowing in healthy participants.Dysphagia, 27, 307–317.
    • Clayton, N. A., Carnaby-Mann, G. D., Peters, M. J., & Ing, A. J. (2012). The effect of chronic obstructive pulmonary disease on laryngopharyngeal sensitivity.Ear Nose & Throat Journal, 91(9), 370–382.
    • Coghlan, K., & Skoretz, S. (2017). Breathing and swallowing with high flow nasal cannula therapy.Perspectives of the ASHA Special Interest Groups, 2(3), 74–81.
    • Coyle, J. L. (2010). Ventilation, respiration, pulmonary diseases, and swallowing.SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 19(4), 91–97.
    • Dicpinigaitis, P. (2003). Cough reflex sensitivity in cigarette smokers.Chest, 123(3), 685–688.
    • Fitzmaurice, G., Laird, N., & Ware, J. (2004). Applied longitudinal analysis.: Hoboken, NJ: Wiley.
    • Flores, M. J., Eng, K., Gerrity, E., & Sinha, N. (2019). Initiation of oral intake in patients using high flow nasal Cannula: A retrospective analysis.Perspectives, 4, 522–531.
    • Gross, R. D., Atwood, C. W., Grayhack, J. P., & Shaiman, S. (2003). Lung volume effects on pharyngeal swallowing physiology.Journal of Applied Physiology, 95(6), 2211–2217.
    • Groves, N., & Tobin, A. (2007). High flow nasal oxygen generates positive airway pressure in adult volunteers.Australian Critical Care, 20(4), 126–131.
    • Hammer, M. J., & Barlow, S. M. (2010). Laryngeal somatosensory deficits in Parkinson's disease: Implications for speech respiratory and phonatory control.Experimental Brain Research, 201(3), 401–409.
    • Hori, R., Isaka, M., Oonishi, K., Yabe, T., & Oku, Y. (2016). Coordination between respiration and swallowing during non-invasive positive pressure ventilation.Respirology, 21(6), 1062–1067.
    • Kijima, M., Isono, S., & Nishino, T. (1999). Coordination of swallowing and phases of respiration during added respiratory loads in awake subjects.American Journal of Respiratory and Critical Care Medicine, 159(6), 1898–1902.
    • Leder, S. B., Siner, J. M., Bizzarro, M. J., McGinley, B. M., & Lefton-Greif, M. A. (2015). Oral alimentation in neonatal and adult populations requiring high-flow oxygen via nasal cannula.Dysphagia, 31(2), 154–159.
    • Leopold, M. A., & Kagel, M. C. (1997). Dysphagia—Ingestion or deglutition? A proposed paradigm.Dysphagia, 12(4), 202–206.
    • Martin, R. E., Goodyear, B. G., Gati, J. S., & Menon, R. S. (2001). Cerebral cortical representation of automatic and volitional swallow in humans.Journal of Neurophysiology, 85(2), 938–950.
    • Martin-Harris, B. (2003). Integration of breathing and oropharyngeal swallowing: A historical perspective and 13-year research experience.SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 12(3), 6–12.
    • Martin-Harris, B. (2008). Clinical implications of respiratory-swallowing interactions.Current Opinion in Otolaryngology & Head and Neck Surgery, 16(3), 194–199.
    • Martin-Harris, B., Brodsky, M. B., Michel, Y., Castell, D. O., Schleicher, M., Sandidge, J., … Blair, J. (2008). MBS measurement tool for swallow impairment—MBSImp: Establishing a standard.Dysphagia, 23(4), 392–405.
    • Mendez-Tellez, P. A., Nusr, R., Feldman, D., & Needham, D. M. (2012). Early physical rehabilitation in the ICU: A review for the neurohospitalist.The Neurohospitalist, 2(3), 96–105.
    • Mirzakhani, H., Williams, J., Mello, J., Joseph, S., Meyer, M., Waak, K., & Eikermann, M. (2014). Muscle weakness predicts pharyngeal dysfunction and symptomatic aspiration in long-term ventilated patients.Survey of Anesthesiology, 58(3), 106.
    • Nakajoh, K., Nakagawa, T., Sekizawa, K., Matsui, T., Arai, H., & Sasaki, H. (2000). Relation between incidence of pneumonia and protective reflexes in post-stroke patients with oral or tube feeding.Journal of Internal Medicine, 247(1), 39–42.
    • Niimi, A., Matsumoto, H., Ueda, T., Takemura, M., Suzuki, K., Tanaka, E., … Amitani, R. (2002). Impaired cough reflex in patients with recurrent pneumonia.Thorax, 58(2), 152–153.
    • Nishimura, M. (2016). High-flow nasal cannula oxygen therapy in adults: Physiological benefits indication, clinical benefits and adverse effects.Journal of Respiratory Care, 61(4), 529–541.
    • Oomagari, M., Fujishima, I., Katagiri, N., Arizono, S., Watanabe, K., Ohno, T., & Ohgi, S. (2015). Swallowing function during high-flow nasal cannula therapy.9.2 Physiotherapists.
    • Papazian, L., Corley, A., Hess, D., Fraser, J. F., Frat, J., Guitton, C., … Azoulay, E. (2016). Use of high-flow nasal cannula oxygenation in ICU adults: A narrative review.Intensive Care Medicine, 42(9), 1336–1349.
    • Peladeau-Pigeon, M., & Steele, C. (2013). Technical aspects of a videofluoroscopic swallowing study understanding.Canadian Journal of Speech-Language Pathology and Audiology, 37(3), 216–226.
    • Rosenbek, J. C., Robbins, J. A., Roecker, E. B., Coyle, J. L., & Wood, J. L. (1996). A Penetration-Aspiration Scale.Dysphagia, 11, 93–98.
    • Sanuki, T., Mishima, G., Kiriishi, K., Watanabe, T., Okayasu, I., Kawai, M., … Ayuse, T. (2016). Effect of nasal high-flow oxygen therapy on the swallowing reflex: An in vivo volunteer study.Clinical Oral Investigations, 21, 915–920.
    • Setzen, M., Cohen, M. A., Mattucci, K. F., Perlman, P. W., & Ditkoff, M. K. (2001). Laryngopharyngeal sensory deficits as a predictor of aspiration.Otolaryngology—Head & Neck Surgery, 124(6), 622–624.
    • Setzen, M., Cohen, M. A., Perlman, P. W., Belafsky, P. C., Guss, J., Mattucci, K. F., & Ditkoff, M. K. (2003). The association between laryngopharyngeal sensory deficits, pharyngeal motor function, and the presence of aspiration with thin liquids.Otolaryngology—Head & Neck Surgery, 128(1), 99–102.
    • Verbeke, G., & Molenberghs, G. (2000). Linear mixed models for longitudinal data. New York, NY: Springer-Verlag.
    • Ward, J. J. (2013). High-flow oxygen administration by nasal cannula for adult and perinatal patients.Respiratory Care, 58(1), 98–122.
    • Wilkinson, D., Andersen, C., O'Donnell, C. P. F., & De Paoli, A. G. (2016). High flow nasal cannula for respiratory support in preterm infants.Cochrane Database of Systematic Reviews, 2011(5), 1–33.
    • Winchester, J., & Winchester, C. C. (2015). Cognitive dysphagia and effectively managing the five systems.SIG 15 Perspectives on Gerontology, 20, 116–132.

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