Pre-Tracheostomy Feeding Does Not Increase Aspiration Risk

Continuing enteral nutrition (EN) before elective tracheostomy may be a safe alternative to routine pre-procedural fasting in critically ill patients, according to a prospective study. Researchers found no statistically significant increase in aspiration pneumonia among mechanically ventilated patients who remained on continuous enteral feeding compared with those who fasted before the procedure.

Pre-procedural fasting is widely practised before tracheostomy to reduce the perceived risk of aspiration. However, interrupting nutritional support can compromise caloric intake and metabolic stability in critically ill patients, prompting questions about whether fasting is always necessary.

Feeding Strategy Did Not Affect Aspiration Risk

Researchers conducted a prospective observational study involving mechanically ventilated adults undergoing elective percutaneous tracheostomy in the intensive care unit of a tertiary hospital.

Ninety-one patients were included in the final analysis, with 45 continuing enteral nutrition until the procedure and 46 following the conventional fasting protocol.

The primary outcome was the incidence of aspiration pneumonia within 72 hours of tracheostomy.

Aspiration pneumonia occurred in 6.7% of patients who continued enteral feeding and 4.4% of those who fasted. Although the rate was numerically higher in the feeding group, the difference was not statistically significant, and the confidence intervals were wide, indicating uncertainty around the estimate.

Respiratory Outcomes Were Comparable

Baseline characteristics, disease severity, and respiratory status were similar between the two groups before tracheostomy.

Following the procedure, patients in the fasting group required significantly higher inspired oxygen concentrations (FiO₂), while other respiratory parameters and arterial blood gas measurements remained comparable.

Further analysis showed that patients who continued enteral feeding experienced greater improvements in arterial oxygen levels (PaO₂) and maintained more stable lactate concentrations after tracheostomy, suggesting that ongoing nutritional support did not adversely affect physiological recovery.

No Differences in Length of Stay or Mortality

The investigators found no significant differences between the feeding and fasting groups in rates of procedure-related complications, intensive care unit or hospital length of stay, or mortality.

These findings suggest that maintaining enteral nutrition before tracheostomy does not appear to compromise short-term clinical outcomes when passive nasogastric drainage is used.

Larger Trials Needed

The authors conclude that continuing enteral nutrition before elective tracheostomy was not associated with a statistically significant increase in aspiration pneumonia or other adverse outcomes compared with conventional fasting.

However, they caution that the study recorded relatively few aspiration events, limiting the precision of the findings. As a result, clinically important differences cannot be ruled out.

The researchers recommend larger, adequately powered prospective studies to determine whether routine fasting before tracheostomy is necessary and to help inform evidence-based nutritional protocols for critically ill patients undergoing the procedure.

Reference

Ekin S  et al. Impact of pre-tracheostomy continuous enteral feeding on aspiration pneumonia risk and clinical outcomes: a prospective observational study. BMC Pulm Med. 2026:DOI: 10.1186/s12890-026-04548-w.