Chronic tracheostomy care of ventilator‐dependent and ‐independent children: Clinical practice patterns of pediatric respirologists in a publicly funded (Canadian) healthcare system

Abstract

Objectives: To describe the current clinical practice patterns of Canadian pediatric respirologists at pediatric tertiary care institutions regarding chronic tracheostomy tube care and management of home invasive ventilation. Methods: A pediatric respirologist/pediatrician with expertise in tracheostomy tube care and home ventilation was identified at each Canadian pediatric tertiary care center to complete a 59-item survey of multiple choice and short answer questions. Domains assessed included tracheostomy tube care, caregiver competency and home monitoring, speaking valves, medical management of tracheostomy complications, decannulation, and long-term follow-up. Results: The response rate was 100% (17/17) with all Canadian tertiary care pediatric centers represented and heterogeneity of practice was observed in all domains assessed. For example, though most centers employ Bivona™ (17/17) and Shiley™ (15/17) tracheostomy tubes, variability was observed around tube change, re-use, and cleaning practices. Most centers require two trained caregivers (14/17) and recommend 24/7 eyes on care and oxygen saturation monitoring. Discharge with an emergency tracheostomy kit was universal (17/17). Considerable heterogeneity was observed in the timing and use of speaking valves and speech-language assessment. Inhaled anti-pseudomonal antibiotics are employed by most centers (16/17) though the indication, agent, and protocol varied by center. Though decannulation practices varied considerably, the requirement of upper airway patency was universally required to proceed with decannulation (17/17) independent of ongoing ventilatory support requirements. Conclusion: Considerable variability in pediatric tracheostomy tube care practice exists across Canada. These results will serve as a starting point to standardize and evaluate tracheostomy tube care nationally.

Tracheostomy and long‐term invasive ventilation decision‐making in children: A scoping review

“…The literature included in this review points to the highly technologized landscape of decision-making that unfolds within the intersecting yet, at times, varied sociocultural beliefs of HCPs and family-caregivers. 11,52,57,72,78,79 While children with tracheostomy/LTV may be considered as the prototypical example of children living with medical complexity, 80 they are but one example. There are children dependent on such technologies as ventricular assist devices, pacemakers, parenteral nutrition, gastric and other enteral feeding tube feeding, dialysis, and so forth.…”

“…The literature included in this review points to the highly technologized landscape of decision‐making that unfolds within the intersecting yet, at times, varied sociocultural beliefs of HCPs and family‐caregivers 11,52,57,72,78,79 . While children with tracheostomy/LTV may be considered as the prototypical example of children living with medical complexity, 80 they are but one example.…”

Management of respiratory problems in children on home invasive mechanical ventilation

“…Among the approaches; salivary gland botox injection, nutritional assessment, gastrostomy feeding, humidifier thorough tracheal masks, enteral glycopyrrolate administration, salivary gland duct ligation, and scopolamine patches. 8…”

Management of respiratory problems in children on home invasive mechanical ventilation

“…Silver nitrate is the most recommended first-line agent for the treatment of granulomas, while other recommended agents include ciprofloxacin-dexamethasone otic suspension, topical steroid ointments, frequent dressing changes, or topical antibiotics 8 . One study noted the choice of cuffless cannulas to ensure the possibility of using speaking valves and to reduce tracheal trauma.…”