2026 Volume 30 Issue 1 Pages 46-53
Introduction: This study aimed to evaluate the feeding and swallowing function of tracheostomized patients under mechanical ventilation and to investigate the feasibility and safety of initiating direct swallowing training at an early stage.
Materials and Methods: This was a retrospective observational study. The subjects were patients admitted to the intensive care unit (ICU) of Nagoya Ekisaikai Hospital between December 2022 and December 2023, who underwent tracheostomy, required mechanical ventilation for more than 48 hours, received intervention by a speech-language-hearing therapist (ST), and did not meet any exclusion criteria. Data were retrospectively collected from medical records, including patient demographics, hospitalization course, swallowing assessment parameters, and the occurrence of adverse events following swallowing assessment or the initiation of direct swallowing training. Swallowing assessments were initiated based on predefined criteria, including level of consciousness, absence of sedatives and vasopressors, and ventilator settings. The assessments were conducted over three consecutive days using a protocol based on the Modified Evan’s Blue Dye Test. If aspiration was suspected, the evaluation was repeated using constant-flow oxygen delivered through the subglottic suction port. When no signs of aspiration or changes in vital signs or respiratory patterns were observed, the assessment was considered passed, and direct swallowing training was initiated by the ST under the supervision of a physician or nurse. When constant-flow oxygen was required during assessment, it was also used during the training sessions.
Results: A total of 10 patients were included (median age: 73 years; 4 males and 6 females). Direct swallowing training was completed without respiratory complications in nine patients. However, one patient developed pneumonia after the initiation of training, which hindered ventilator weaning.
Conclusion: With clearly defined initiation criteria and appropriate risk management, direct swallowing training may be feasible, with careful monitoring, in tracheostomized patients requiring mechanical ventilation.
