Increased Risk for Gastric Aspiration with High Flow Nasal Cannula (HFNC) Therapy

Preventing Gastric aspiration becomes even more critical as reflux related aspiration is a major cause for contamination of the lungs with bacteria, potentially leading to increased morbidity and mortality in patients with COVID-19.


A recently published case report conducted at the Rabin Medical Center in Israel has found a drastic surge in reflux events in a patient with High flow nasal canula oxygen therapy (HFNC). This may raise concerns particularly for COVID-19 patients. The report shows that when using (HFNC) reflux rates are exponentially increased (compared to when using endotracheal tubes) which poses an immediate risk for the patient to suffer massive reflux events potentially causing a secondary gastric aspiration pneumonia.

A report published in the Lancet recommends the use of HFNC ventilation in patients with Coronavirus in order to avoid intubation. This makes it paramount that preventative measures to avoid gastric aspiration are put in place.

To read the full case report titled Reflux events detected bymultichannel bioimpedance smart feeding tube during high flow nasal cannula oxygen therapy and enteral feeding: First case report, published in the Journal for Critical Care, 2020: Click here.

Countering Gastric Aspiration

  • The World Health Organization (WHO) recommends the elevation of the head-of-bed by 30 - 45 degrees
  • The use of sensors to detect reflux events
  • The use of a specialized feeding system that prevents gastric content from entering the lungs

Case Report

Patient (female, 69 years) admitted for sepsis and suspected occlusion.

Patient was enterally fed and monitored using the smART+ system, which includes a nasogastric tube equipped with multiple sensors to detect reflux and with an automatic secession of feeding, dynamic gastric evacuation and inflation of a balloon (in major reflux events) to prevent aspiration of gastric matter.

During a period of 440 minutes of HFNC therapy, the patient experienced a total of 330 minutes of reflux and a total of 33ml of gastric content that were evacuated by the smART+ system in real time in order to prevent tracheal aspiration.

In comparison, after receiving HFNC therapy, the patient was re-intubated the reflux events decreased accordingly.

Led by former ESPEN chairman Prof. Pierre Singer.

Preventing gastric aspiration

Draining excess gastric pressure and content and automatically compensating the missing energy

Residuals are evacuated to a residual bag during massive or extended reflux events to reduce gastric pressure and reflux time.

The system takes into account the drained gastric content and compensates nutritional losses to achieve the patient’s nutritional target and ensure optimal feeding efficiency.

Using smART+ Sensors to detect and prevent reflux events in the ICU.

The data also provides a solid premise from which clinical decisions can be made

The algorithm processes the data collected by the sensors and enables the system to take immediate and automatic actions to prevent aspiration.

The sensors detect and log the natural history of the patient’s reflux events.

The smART+ Platform
Precise. Personalized. Safe.