Dysphagia in Patients With High-Flow Nasal Cannulas: Risk and Practice Implications

BACKGROUND: High-flow nasal cannula (HFNC) therapy is often used in critical care, but its effects on swallowing function remain unclear. Dysphagia in hospitalized patients is associated with complications and prolonged length of stay, yet screening and referral practices vary widely. Limited evidence exists to guide evaluation of dysphagia risk factors among patients receiving HFNC therapy. OBJECTIVES: To identify patients most at risk for developing dysphagia during HFNC therapy and to examine differences in clinical outcomes based on dysphagia status. METHODS: This retrospective chart audit reviewed adult inpatients (≥21 years) who received HFNC therapy between 2022 and 2024. Of 1038 eligible patients, 210 were randomly selected for chart audit; 195 were included after exclusions. Data included HFNC settings, dysphagia status, and clinical outcomes. RESULTS: No dose-response relationship was identified between dysphagia and HFNC settings, including flow rate, fraction of inspired oxygen, or duration. Dysphagia during admission was not associated with mortality (all P's > .36) or preexisting dysphagia status (χ2 = 3.7, P = .16). However, patients with dysphagia had longer intensive care unit stays than patients without dysphagia and patients with unknown dysphagia status (P = .04 and P = .09, respectively), and dysphagia status was associated with intubation (χ2 = 13.6, P = .001), with intubation most common among patients with dysphagia. CONCLUSIONS: This cohort showed no association of HFNC settings with dysphagia status, and no specific triggers were identified to inform standardized dysphagia screening protocols for patients receiving HFNC therapy. Dysphagia was associated with intubation and prolonged intensive care unit stay.