The Influence of Airflow Via High-Flow Nasal Cannula on Duration of Laryngeal Vestibule Closure

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Abstract

The purpose of this experimental study was to investigate the influence of airflow via high-flow nasal cannula (HFNC) on the duration of laryngeal vestibule closure (dLVC) and Penetration-Aspiration Scale (PAS) scores. Twenty-nine healthy adults participated in a repeated-measures design. Each participant completed a videofluoroscopic swallow study while receiving airflow via HFNC across a control condition of zero flow and conditions of 10, 20, 30, 40, 50, and 60 L/min. Five raters rated dLVC and PAS scores. Laryngeal vestibule closure was complete on all swallows. Linear regression revealed that the amount of airflow via HFNC significantly influenced dLVC, F(1, 810) = 19.056 , p < .001. The mode of airway invasion for each airflow condition was PAS 2, with > 80% frequency compared to other PAS scores. Aspiration (PAS 7 or 8) did not occur. A Fisher's Exact test determined there was no association between normal/abnormal PAS score and no airflow/HFNC ( p = .610). Findings indicate that for healthy adults, airflow via HFNC influenced dLVC in a dose-dependent manner with no change in airway invasion. The influence of HFNC on dLVC was a positive relationship, meaning when airflow increased, dLVC increased, and when airflow decreased, dLVC decreased. Modulation of dLVC in response to the amount of airflow highlights the ability of healthy adults to adapt to swallow conditions as needed to protect the airway.

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Nasal high-flow therapy delivers low level positive airway pressure

R. Parke, S. McGuinness, M. Eccleston (2009)

Background The aim of this prospective study was to determine whether a level of positive airway pressure was generated in participants receiving nasal high flow (NHF) delivered by the Optiflow™ system (Fisher and Paykel Healthcare Ltd, Auckland, New Zealand) in a cardiothoracic and vascular intensive care unit (ICU). Methods Nasopharyngeal airway pressure was measured in 15 postoperative cardiac surgery adult patients who received both NHF and standard facemask therapy at a flow rate of 35 litre min−1. Measurements were repeated in the open mouth and closed mouth positions. Mean airway pressure was determined by averaging the pressures at the peak of inspiration of each breath within a 1 min period, allowing the entire pressure profile of each breath to be included within the calculation. Results Low level positive pressure was demonstrated with NHF at 35 litre min−1 with mouth closed when compared with a facemask. NHF generated a mean nasopharyngeal airway pressure of mean (sd) 2.7 (1.04) cm H2O with the mouth closed. Airway pressure was significantly higher when breathing with mouth closed compared with mouth open (P≤0.0001). Conclusions This study demonstrated that a low level of positive pressure was generated with NHF at 35 litre min−1 of gas flow. This is consistent with results obtained in healthy volunteers. Australian Clinical Trials Registry www.actr.org.au ACTRN012606000139572.

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Temporal and biomechanical characteristics of oropharyngeal swallow in younger and older men.

J A Logemann, B Pauloski, Carin M. A. Rademaker … (2000)

As the U.S. population ages, there is increasing need for data on the effects of aging in healthy elderly individuals over age 80. This investigation compared the swallowing ability of 8 healthy younger men between the ages of 21 and 29 and 8 healthy older men between the ages of 80 and 94 during two swallows each of 1 ml and 10 ml liquid. Videofluoroscopic studies of these swallows were analyzed to confirm the absence of swallowing disorders. Biomechanical analysis of each swallow was completed, from which data on temporal, range of motion, and coordination characteristics of the oropharyngeal swallow were taken. Position of the larynx at rest, length of neck, and pattern of hyoid bone movement were also compared between the two groups. None of the younger or older men exhibited any swallowing disorders. The C2 to C4 distance of older men was significantly shorter than that of younger men, and laryngeal position at rest was lower than in younger men but not significantly so. Older men had a significantly longer pharyngeal delay than younger men and significantly faster onset of posterior pharyngeal wall movement in relation to first cricopharyngeal opening. The older men exhibited significantly reduced maximum vertical and anterior hyoid movement as compared to the younger men even when accounting for the difference in C2 to C4 distance in older men. These data support the hypothesis of reduced muscular reserve in the swallows of older men as compared to younger men. Older men also exhibited less width of cricopharyngeal opening than younger men at 10 ml volume, indicating less upper esophageal sphincter flexibility in the swallows of older men. The potential for exercise to improve reserve is discussed. Significant changes in extent of hyoid elevation and duration of cricopharyngeal opening were seen as liquid bolus volume increased.

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Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients.

L Brochard, C Brun-Buisson, C Delclaux … (2000)

Invasive life-support techniques are a major risk factor for nosocomial infection. Noninvasive ventilation (NIV) can be used to avoid endotracheal intubation and may reduce morbidity among patients in intensive care units (ICUs). To determine whether the use of NIV is associated with decreased risk of nosocomial infections and improved survival in everyday clinical practice among patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) or hypercapnic cardiogenic pulmonary edema (CPE). Matched case-control study conducted in the medical ICU of a French university hospital from January 1996 through March 1998. Fifty patients with acute exacerbation of COPD or severe CPE who were treated with NIV for at least 2 hours and 50 patients treated with mechanical ventilation between 1993 and 1998 (controls), matched on diagnosis, Simplified Acute Physiology Score II, Logistic Organ Dysfunction score, age, and no contraindication to NIV. Rates of nosocomial infections, antibiotic use, lengths of ventilatory support and of ICU stay, ICU mortality, compared between cases and controls. Rates of nosocomial infections and of nosocomial pneumonia were significantly lower in patients who received NIV than those treated with mechanical ventilation (18% vs 60% and 8% vs 22%; P<.001 and P =.04, respectively). Similarly, the daily risk of acquiring an infection (19 vs 39 episodes per 1000 patient-days; P =.05), proportion of patients receiving antibiotics for nosocomial infection (8% vs 26%; P =.01), mean (SD) duration of ventilation (6 [6] vs 10 [12] days; P =.01), mean (SD) length of ICU stay (9 [7] vs 15 [14] days; P =.02), and crude mortality (4% vs 26%; P =.002) were all lower among patients who received NIV than those treated with mechanical ventilation. Use of NIV instead of mechanical ventilation is associated with a lower risk of nosocomial infections, less antibiotic use, shorter length of ICU stay, and lower mortality. JAMA. 2000;284:2361-2367.

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Contributors

Katie Allen:

ORCID: http://orcid.org/0000-0001-9384-5843

2katieallen@gmail.com

Bio :

Katie Allen

PhD CCC-SLP

Kristine Galek:

ORCID: http://orcid.org/0000-0002-3398-7513

Kgalek@med.unr.edu

Bio :

Kristine Galek

PhD CCC-SLP

Journal

Journal ID (nlm-ta): Dysphagia

Title: Dysphagia

Publisher: Springer US (New York )

ISSN (Print): 0179-051X

ISSN (Electronic): 1432-0460

Publication date (Electronic): 1 October 2020

Pages: 1-7

Affiliations

GRID grid.266818.3, ISNI 0000 0004 1936 914X, University of Nevada, ; 1664 North Virginia Street, Mailstop 0152, Reno, NV 89557 USA

Author information

Katie Allen http://orcid.org/0000-0001-9384-5843

Kristine Galek http://orcid.org/0000-0002-3398-7513

Article

Publisher ID: 10193

DOI: 10.1007/s00455-020-10193-0

PMC ID: 7529319

PubMed ID: 33006075

SO-VID: d17fde48-3016-45d4-86df-3b30024e5262

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This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

History

Date received : 22 May 2020

Date accepted : 21 September 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100011347, University of Nevada, Reno;

The Influence of Airflow Via High-Flow Nasal Cannula on Duration of Laryngeal Vestibule Closure

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Most cited references 59

Nasal high-flow therapy delivers low level positive airway pressure

Temporal and biomechanical characteristics of oropharyngeal swallow in younger and older men.

Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients.

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