Oral Alimentation in Neonatal and Adult Populations Requiring High-Flow Oxygen via Nasal Cannula
Oral Alimentation in Neonatal and Adult Populations Requiring High-Flow Oxygen via Nasal Cannula
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DOI：
10.1007/s00455-015-9669-3
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发表时间：
2016-04-01
期刊：
影响因子：
2.6
通讯作者：
Lefton-Greif, Maureen A.
中科院分区：
文献类型：
--
作者：
Leder, Steven B.;Siner, Jonathan M.;Lefton-Greif, Maureen A.
在重症监护室（ICU）环境中，通过鼻插管（HFO 2-NC）使用高流量氧气越来越常见。尽管呼吸和吞咽之间的关键界面，以及ICU中患者的高紧急度，但HFO 2-NC对进食和吞咽的影响尚不清楚。本前瞻性、单中心、队列研究调查了HFO 2-NC使用对新生儿和成人ICU患者口服营养的影响。在100例连续ICU住院患者（50例新生儿和50例成人）中评价了口服营养状态，这些患者需要HFO 2-NC。记录了参与者的特征、呼吸支持、新生儿成功开始经口喂养以及成人成功恢复经口喂养。儿科医生和护理人员认为17/50例（34%）需要HFO 2-NC的新生儿在发育和医学上适合开始口服营养。所有17例（100%）均成功开始经口喂养。50例患者中的33例（66%）由于早产或在数据收集时无法口服营养的医学状况而继续口服零剂量。重症监护医师和护理人员认为需要HFO 2-NC的50名成人中有39名（78%）在医学上适合恢复口服营养（n = 34）或功能性吞咽，FEES无误吸（n = 5）。所有39例（100%）恢复口服营养成功. 50例患者中有11例（22%）在数据收集时由于严重呼吸问题而无法进行吞咽试验和口服营养，经口给药后继续为零。所有发育和医学上适当的需要HFO 2-NC的新生儿和成人患者均成功引入或恢复口服营养。需要HFO 2-NC的患者被确定为存在进食或吞咽问题，应使用与不需要HFO 2-NC的患者相同的标准进行吞咽评价，因为不是使用HFO 2-NC，而是患者特定的进食和吞咽准备的决定因素及其潜在的医疗状况影响口服营养状态的准备。
Use of high-flow oxygen via nasal cannula (HFO2-NC) is increasingly common in intensive care unit (ICU) settings. Despite the critical interface between respiration and swallowing, and the high acuity of patients in ICUs, the impact of HFO2-NC on feeding and swallowing is unknown. The present prospective, single-center, cohort study investigated the impact of HFO2-NC use on oral alimentation in neonatal and adult ICU patients. Oral alimentation status was evaluated in 100 consecutive ICU inpatients (50 neonatal and 50 adult) requiring HFO2-NC. Participant characteristics, respiratory support, successful initiation of oral feeding in neonates, and successful resumption of oral feeding in adults were recorded. Seventeen of 50 (34 %) neonates requiring HFO2-NC were deemed developmentally and medically appropriate by the neonatologist and nursing to begin oral alimentation. All 17 (100 %) were successful with initiation of oral feedings. Thirty-three of 50 (66 %) continued nil per os due to prematurity or medical conditions precluding oral alimentation at time of data collection. Thirty-nine of 50 (78 %) adults requiring HFO2-NC were deemed medically appropriate by the intensivist and nursing to resume oral alimentation (n = 34) or with a functional swallow without aspiration on FEES (n = 5). All 39 (100 %) resumed oral alimentation successfully. Eleven of 50 (22 %) continued nil per os due to severe respiratory issues precluding both swallow testing and oral alimentation at time of data collection. All developmentally and medically appropriate neonatal and adult patients requiring HFO2-NC were successful with either the introduction or resumption of oral alimentation. Patients requiring HFO2-NC who are identified as having feeding or swallowing issues should be referred for swallowing evaluations using the same criteria as patients who do not require HFO2-NC, as it is not the use of HFO2-NC but rather patient-specific determinants of feeding and swallowing readiness and their underlying medical conditions that impact readiness for oral alimentation status.