Pediatric tracheostomy surveillance

Abstract

We report an unusual case of a 14-month-old ex-28 week, ventilator-dependent male with a history of bronchopulmonary dysplasia and tracheostomy at 2 months of age. Lost to follow-up, at age 9 months, he presented to the emergency department with worsening respiratory distress. The patient was taken to the operating room at which time direct visualization of the airway demonstrated a mass filling the entire glottic inlet without supraglottic or pharyngeal mucosal attachments. The solid, nonvascular, mass appeared to be emanating from a suprastomal site. Excision proved to relieve the airway obstruction and postoperatively the patient has thrived.

Utility of telemedicine in tracheostomy‐dependent children

“…Routine surveillance in‐person tracheoscopy and direct laryngoscopy and bronchoscopy in the operating room are still warranted to identify development of granulation tissue, monitor for appropriateness of tracheostomy size, and evaluate for the possibility of decannulation. 13 …”

“…These findings highlight a major limitation of telemedicine: the inability to perform a tracheoscopy, which is critical in the aforementioned clinical situations to assess and/or establish a safe airway. Routine surveillance in-person tracheoscopy and direct laryngoscopy and bronchoscopy in the operating room are still warranted to identify development of granulation tissue, monitor for appropriateness of tracheostomy size, and evaluate for the possibility of decannulation 13. As the global healthcare community aims to improve the care and safety of tracheostomy-dependent children, telemedicine should serve as an effective adjunct to achieve that mission.…”