Vented Trach and PO Intake

[ICUBSNRN7]

There's a frequent flyer in my ICU who is a chronic trach on the ventilator. 
I understand why trached patients who are on the Trach collar have an actual diet, but it just seems so unsafe to me to be giving a trach and vent patient water and sips with meds when they are on the vent. Especially when they have a PEG tube that works. 
this patient specifically has a history of aspiration, pneumonia, and thick secretions. She typically comes into the ED in need of a bronch due to her secretions and history of plugging off. Additionally, she has a chronic cuff leak. 
Is it my lack of experience that makes me think that this entire idea is unsafe? I feel like there's just no way it's safe.... 
 

[MaxAttack, BSN, RN]

Good question. I think the general assumption is that when someone's on a vent they are not to get anything PO.

However, after a quick look online I found this:

https://journals.sagepub.com/doi/pdf/10.1177/175114371401500414

Quote

There is little if any strong evidence that cuff inflation significantly increases the risk of serious harm related to aspiration per se. Our experience over several years is that offering oral rather than NG tube feeding to selected patients with tracheostomies is well tolerated and has several advantages

Granted this is one source but I learned something. In this instance, I would refer to the SLP notes.

[JBMmom, MSN, NP]

I think this has to be a very case by case decision. If this patient has a history of aspiration, have they had goals of care discussions about the issue? If eating by mouth is an important point for this patient's quality of life, and it's been done in the past, I would not step in and refuse. However, if it hasn't been really hashed out as far as the risk benefit ratio, I might try to have that conversation and clarify what's really best for the patient.