Q: Can patients receiving mechanical ventilation with a tracheostomy eat?

A: Maureen A. Seckel, RN, APN, ACNS-BC, CCNS, CCRN, and Kim Schulenburg, MA CCC-SLP, reply:

Swallowing dysfunction or dysphagia occurs in approximately 50% of patients with a tracheostomy receiving mechanical ventilation, with elderly patients at higher risk.1,2  Patients with prior dysphagia, concomitant neuromuscular disease, or other comorbid conditions are at much higher risk. A tracheostomy alone creates an open hole in a closed system. Airflow in these patients bypasses the larynx during inhalation and exhalation because the tracheostomy tube is located below the level of the vocal cords (see Figure). These airflow and pressure changes lead to disruption of the normal adduction of the vocal cords, folding of the false vocal cords, closure of the entrance to the laryngeal vestibule, inversion of the epiglottis, and upward movement of...

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