Accelerating tracheostomy decannulation with intermittent oro-esophageal feeding in neurogenic dysphagia: a multicenter randomized controlled trial
In brief
Oro-esophageal tube feeding cut time to decannulation by four days
In a randomized trial of 140 tracheostomized adults with neurogenic dysphagia, intermittent oro-esophageal feeding shortened time to decannulation by about four days compared with nasogastric feeding. Successful decannulation within 30 days was also more common, by about 19 percentage points, alongside better nutrition and swallowing measures; whether these benefits hold beyond the three Chinese centers remains unknown.
- Journal
- Critical care (London, England) (Q1)
- Published
- 4 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Qing Li, Danhong Hu, Bo Yang, Chenxi Zhang, Ting Zhou, Pan Li, et al.
- PMID
- 42968156
- DOI
- 10.1186/s13054-026-06235-y
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (top studies of the week, 8 November 2026): Tracheostomy decannulation and nutrition in dysphagic patients
Abstract
BACKGROUND: Neurogenic dysphagia frequently constitutes a major barrier to decannulation for tracheostomized patients. Conventional nasogastric tube (NGT) feeding may promote disuse atrophy of swallowing musculature and persistent aspiration risk. Intermittent oro-esophageal tube (IOE) feeding, a physiologically oriented modality mimicking natural swallowing, may accelerate decannulation, yet high-quality evidence is lacking. METHODS: In this multicenter randomized controlled trial conducted at three tertiary academic centers in China, tracheostomized adults with neurogenic dysphagia were randomly assigned 1:1 to IOE or NGT. All participants received standardized pharmacological treatment, pulmonary rehabilitation, and structured swallowing training, and entered an institutional decannulation protocol with predefined readiness criteria. The primary outcome was time from protocol entry to actual decannulation. Secondary outcomes included the 30-day successful decannulation rate, nutritional indices, swallowing function, and swallowing-related quality of life. Outcome assessors and statisticians were blinded to allocation. Analyses followed the intention-to-treat principle. RESULTS: A total of 140 patients were randomized to IOE (n = 70) or NGT (n = 70). Time to decannulation was shorter with IOE (22.16 ± 1.86 vs. 26.33 ± 1.30 days; between-group difference, 4.17 days; 95% confidence interval [CI], 1.90-6.44; p < 0.001; log-rank p = 0.005). The 30-day successful decannulation rate was higher with IOE (65.71% vs. 47.14%; absolute difference, 18.57% points; 95% CI, 2.43-34.71; p = 0.028). At 1 month, the IOE group demonstrated greater improvements in body mass index, serum albumin, serum prealbumin, swallowing function, and swallowing-related quality of life (all p < 0.001). Pharyngeal discomfort was less frequent with IOE (14.06% vs. 34.21%; p = 0.006); no Grade Ⅲ or higher adverse events occurred. CONCLUSIONS: Intermittent oro-esophageal tube feeding shortens time to decannulation and improves nutritional, swallowing, and quality-of-life outcomes compared with nasogastric tube feeding in tracheostomized patients with neurogenic dysphagia. TRIAL REGISTRATION: ClinicalTrials.gov, NCT06791590, registration date January 19, 2025.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.