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Experience with the home-care of tracheotomised paediatric patients
J B Campbell1, D W Morgan, K Pearman
1Department of Otolaryngology, Birmingham Childrens Hospital, UK.
Insights
Home management of infants with tracheotomies using soft polyvinyl chloride tubes is feasible. This approach facilitates decannulation and improves quality of life for children requiring prolonged airway support.
Area of Science:
- Pediatric Otolaryngology
- Respiratory Medicine
- Home Healthcare
Background:
- Infants with tracheotomies often require prolonged cannulation.
- Home management is desirable for a normal family environment.
- Soft polyvinyl chloride paediatric tracheotomy tubes offer advantages.
Purpose of the Study:
- To evaluate the feasibility and outcomes of home management for infants with tracheotomies.
- To assess the effectiveness of soft polyvinyl chloride tracheotomy tubes in home care.
- To determine the impact on decannulation rates and quality of life.
Main Methods:
- Routinely used soft polyvinyl chloride paediatric tracheotomy tubes (Shiley).
- Modified tubes with fenestrations to improve speech and aid decannulation.
- Trained parents in tracheotomy care for home management.
- Managed 28 infants at home with a median hospitalisation of 12 weeks.
Main Results:
- Median home management duration was 94 weeks.
- 16 out of 28 patients were successfully decannulated.
- The majority of children experienced intermittent chest infections despite supportive measures.
Conclusions:
- Home management of infants with tracheotomies using specific soft tubes is achievable.
- This approach can facilitate decannulation and improve family life.
- Ongoing chest infections remain a concern requiring supportive care.
Abstract:
Many infants with tracheotomies remain cannulated for prolonged periods while the underlying cause of airway obstruction is either treated or natural resolution is awaited (usually by growth). To enable these children to enjoy a relatively normal family environment despite a tracheotomy, it is desirable that they should be managed at home for at least part of the time. For the past 8 years we have routinely used soft polyvinyl chloride paediatric tracheotomy tubes (Shiley) in our patients. These tubes have proved to be relatively resistant to obstruction with secretions and are changed at 1- to 2-week intervals. They can be modified by making a series of three to four 2-mm through-and-through fenestrations around the shoulder in order to improve speech production and facilitate decannulation. Parents are tutored in tracheotomy care, which includes tube changing, humidification and suction. They are then permitted to take their child home from hospital when they are considered to be competent. Twenty-eight children (13 boys, 15 girls) with a mean age of 14.5 weeks (range 1-525 weeks) at the time of tracheotomy have been managed at home using this system. The median period of hospitalisation was 12 weeks (range 5-75 weeks), and the median duration of home management was 94 weeks (range 13-394 weeks). Sixteen patients have been successfully decannulated, 11 remain cannulated and 1 died at home from sudden infant death syndrome. Despite supportive measures, the majority of the children developed intermittent chest infections.(ABSTRACT TRUNCATED AT 250 WORDS)