Weaning patients with dysphagia from tube feeding to oral nutrition: A proposed algorithm

In acute rehabilitation, weaning patients from tube feeding to oral nutrition is a primary nutrition goal. In the Neurocognitive and Neuromuscular Unit at the Chedoke Campus of the Hamilton Health Sciences Corporation, this goal becomes particularly challenging in the presence of dysphagia. This paper presents a proposed two-phase algorithm intended to offer the dietitian a guide for weaning such patients. The algorithm comprises the Preparatory Phase (medical and nutritional stability, swallowing assessment and implementation of an intermittent tube feeding schedule) and the Weaning Phase (covering progress from stimulation feeds through to full oral nutrition and tube withdrawal). The importance of monitoring for aspiration, aspiration pneumonia and dehydration is stressed. Feeding and swallowing strategies, dietary modifications and behavioural and cognitive characteristics necessary for oral intake are described. Withdrawal of the feeding tube post-weaning may enhance quality of life, patient comfort and may maximize options for discharge environments.