Accelerating tracheostomy decannulation with intermittent oro-esophageal feeding in neurogenic dysphagia: a multicenter randomized controlled trial.
9 affiliations
- 1Pulmonary Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Xixiazhuang, Badachu, Shijingshan, Beijing, 100144, China.
- 2Neurological & Critical Care Rehabilitation Department, Hunan Rehabilitation Hospital, Changsha, 410007, China.
- 3High Dependency Unit, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, 450007, China.
- 4School of Biomedical Engineering, Guangzhou Medical University, Guangzhou, 511436, China.
- 5Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.
- 6Institute of Technical Medicine, Furtwangen University, 78120, Villingen-Schwenningen, Germany.
- 7Department of Critical Care Medicine, Peking Union Medical College Hospital, Beijing, 100730, China.
- 8Pulmonary Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Xixiazhuang, Badachu, Shijingshan, Beijing, 100144, China. [email protected].
- 9Pulmonary Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Xixiazhuang, Badachu, Shijingshan, Beijing, 100144, China. [email protected].
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.
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BibTeX
@article{li2026accelerating,
title = {{Accelerating tracheostomy decannulation with intermittent oro-esophageal feeding in neurogenic dysphagia: a multicenter randomized controlled trial.}},
author = {Qing Li and Danhong Hu and Bo Yang and Chenxi Zhang and Ting Zhou and Pan Li and Yajing Wang and Zhanqi Zhao and Liying Sun and Hongying Jiang},
journal = {Critical care (London, England)},
year = {2026},
month = aug,
doi = {10.1186/s13054-026-06235-y},
url = {https://europepmc.org/article/MED/42968156},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Accelerating tracheostomy decannulation with intermittent oro-esophageal feeding in neurogenic dysphagia: a multicenter randomized controlled trial.
AU - Qing Li
AU - Danhong Hu
AU - Bo Yang
AU - Chenxi Zhang
AU - Ting Zhou
AU - Pan Li
AU - Yajing Wang
AU - Zhanqi Zhao
AU - Liying Sun
AU - Hongying Jiang
PY - 2026
DA - 2026/08/04
JO - Critical care (London, England)
DO - 10.1186/s13054-026-06235-y
UR - https://europepmc.org/article/MED/42968156
AB - 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.
SN - 1364-8535
SN - 1466-609X
ER -