Is oral feeding of a patient who is ventilator-dependent and has a chronic indwelling tracheostomy tube acceptable? Isn’t there a risk of aspiration if patients with tracheostomies who do not have feeding tubes take in nourishment by mouth?
—Katherine McClanahan, DO, Las Vegas
The decision to attempt oral feeding of a patient with a chronic tracheostomy is complex and highly dependent on the clinical situation. The risks of aspiration and swallowing dysfunction must be balanced with the physiologic and psychological benefits of oral feeding. Complete documentation of the wishes of the patient and family and of informed consent should be made by the attending physician. The disease process(es) resulting in the need for tracheostomy and mechanical ventilation as well as comorbid conditions must be carefully assessed. The mental status and nutritional needs of the patient, aspiration risk, and goals of a trial of oral feeding are all key considerations. I have had success with oral feeding of several patients in this clinical situation. In general, patients should have sufficient mental clarity to understand and psychologically benefit from oral feeding. An evaluation of swallowing ability and aspiration should be performed by appropriate clinical personnel. A nutritional assessment should ascertain if sufficient caloric and hydration needs can be met via the oral route or if additional enteral and/or parenteral supplementation will be required. Nutritional consultation is also required to determine the optimal form and consistency of the oral diet. Obviously, meticulous nursing care, respiratory therapy support, and continuous supervision by appropriate health personnel are required during the actual feeding process.
—R. Steven Tharratt, MD, MPVM (132-13)