Oral feed for patients with a tracheostomy: Balancing risks and benefits

Abstract

Many patients on the intensive care unit have tracheostomies sited, following which some clinicians advocate that they should be fed via a nasogastric tube, as taking food orally might present a risk of aspiration. However, nasogastric (NG) tubes also have associated risks, harms and costs. The Royal Bolton Hospital is a district general hospital in the UK with an 8-bedded, mixed medical/surgical intensive care unit admitting around 430 level 3 patients per year. We describe our clinical practice in terms of a liberal attitude to offering oral feed to a selected group of patients with tracheostomies in situ. We postulate that this approach has several advantages and that the balance between risk and benefit must be assessed in each individual case. Expert assessment by Speech and Language therapists can help these judgements. Some beliefs regarding aspiration risk in patients with tracheostomies lack supporting evidence.