Mitchell et al1 correctly conclude that further study is necessary to determine survival benefits from feeding tube placement. While feeding tubes may prevent aspiration of food otherwise delivered per os, similar underlying abnormalities responsible for aspiration of salivary and nasal secretions would not be expected to be corrected. It is not surprising, therefore, that aspiration is a leading cause of death among tube-fed nursing home residents.
In this respect, I suggest that mouth care and pharyngeal toilet, including periodic suctioning of the pharynx (eg, every shift), need to be carefully considered in the treatment of tube-fed patients.
The Minimum Data Set resident assessments from which the results of Mitchell and colleagues' study were derived also collects information on whether nursing home residents are treated with suctioning. It would be of interest to determine how many of the 135 tube-fed residents received suctioning and whether there was a survival advantage