Oral feeding aspiration can be a threat to positive οutcomes for patients with tracheostomy who require mechanical ventilation. A review of current literature reveals a high incidence of aspiration in this population. Silent aspiration is particularly common, meaning that bedside evaluations of swallowing function often are unreliable. Advanced practice nurses who are aware of the risk factors for aspiration may be able to improve outcomes for this population. This article presents a review of the literature on oral feeding aspiration in patients with tracheostomies, suggests areas of additional research, and provides nursing implications for the safe care of these patients.