Care of Infants and Children with Tracheostomies: An Official American Thoracic Society Clinical Practice Guideline

Background: The increase in tracheostomies among infants and children, driven by medical advances and evolving family preferences, underscores the need for standardized, evidence-based guidelines. This guideline outlines management recommendations for these medically complex and resource-intensive children with tracheostomies, incorporating best evidence on diagnostic tools and streamlined care protocols. Methods: This Clinical Practice Guideline adheres to American Thoracic Society policies and procedures, using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to form clinical questions, summarize evidence, and develop recommendations with a health equity perspective. A multidisciplinary panel with expertise in pediatric tracheostomy care contributed to recommendations for ethical considerations, discharge processes, in-home caregiver requirements, and diagnostic tools (tracheal aspirate cultures, bronchoscopy, and polysomnography). Results: The panel recommends applying ethical principles to guide shared decision-making about tracheostomy placement (strong recommendation). We also recommend a standardized discharge process involving comprehensive family caregiver training for safe transitions from hospital to home (conditional recommendation). A continuously awake, trained caregiver to manage emergencies is also recommended for high-risk patients (strong recommendation). The panel recommends tracheal aspirate cultures during acute respiratory episodes to guide antibiotic therapy, but not for routine surveillance (conditional recommendation); bronchoscopy for thorough airway examination before tracheostomy decannulation (strong recommendation); and polysomnography before decannulation to ensure respiratory stability (conditional recommendation). Conclusions: These guidelines aim to standardize and improve the management of pediatric patients with tracheostomies by providing evidence-based recommendations for ethical considerations, discharge planning, and diagnostic assessments. Implementing these guidelines aims to enhance patient safety and quality of life through a structured and patient-centered approach.