Exploring Practice Approaches and Opinions of International Speech and Language Therapists in the Assessment and Management of Oropharyngeal Swallowing in Adults on High-flow Nasal Oxygen: A Focus Group Study.

BACKGROUND: Speech language therapists (SLTs) are recognised as key members of the multidisciplinary team in adult critical care and have more recently been assessing and managing swallowing with adults on high-flow nasal oxygen (HFNO). HFNO is a non-invasive respiratory support that delivers a stable fraction of inspired oxygen ranging from 0.21 to 1.0 with flow rates of 15-60 litres per min. Despite HFNO being used routinely in critical care and SLTs postulating an effect of HFNO on oropharyngeal swallowing, there is limited evidence and consensus of potential effects in the literature. Subsequently, there are no clear guidelines or practice patterns for managing dysphagia in this patient cohort. There is limited understanding of how SLTs are interpreting and applying the available literature to their practice patterns. AIM: The aim of this qualitative study was to explore international SLTs' practice approaches and opinions when assessing and managing oropharyngeal swallowing in adults on HFNO. METHODS & PROCEDURES: Participants were SLTs with at least two years of experience working in critical care. Three online focus groups consisting of 18 participants from six countries were conducted. The participants were asked about their current practices, opinions, considerations, and perceptions of challenges and opportunities when assessing and managing adults on HFNO. Inductive content analysis was used to analyse the data. OUTCOMES & RESULTS: Six content categories were identified; 'consider the patient individually and holistically', 'types of assessment procedures', 'impact of HFNO on oropharyngeal swallowing', 'considerations when assessing adults on HFNO', 'current knowledge and practice landscape', and 'collaboration and communication'. A further 15 subcategories were derived. CONCLUSION: This research has identified concerns amongst SLTs that there is a lack of evidence to guide assessment and management of dysphagia in patients receiving HFNO. Research efforts should focus on clarifying how different flow rates impact swallowing function. This would help establish best-practice approaches for screening, assessing, and managing swallowing in patients receiving HFNO. WHAT THIS PAPER ADDS: What is already known on this subject High-flow nasal oxygen (HFNO) is being used more frequently to treat critically-ill adults, however the impact of HFNO on oropharyngeal swallowing has not been fully established. Speech and language therapists (SLTs) are now routinely integrated into the multidisciplinary team in critical care and assess adults on HFNO. To the authors knowledge, no study has previously explored in-depth the perspectives of critical care SLTs who assess and manage oropharyngeal swallowing in adults on HFNO. What this paper adds to the existing knowledge This is the first qualitative study exploring international SLTs opinions and practices when assessing and managing oropharyngeal swallowing in adults on HFNO. This study provides valuable insights into how oropharyngeal swallowing is currently being assessed and managed internationally by SLTs and provides guidance on future research in this area. What are the potential or actual clinical implications of this work? Findings from this study demonstrate variability in clinical practice and highlights uncertainty regarding assessment and management in this patient population. Some participants emphasised the value of instrumental assessment in supporting clinical decision making. This study identified that there are currently no standardised protocols or guidelines for the screening and comprehensive assessment for adults on HFNO. Further research is needed to guide the development of such protocols and guidelines to enable best practice.