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

<b>Background:</b> 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. <b>Methods:</b> 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). <b>Results:</b> 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). <b>Conclusions:</b> 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.

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Publication Details

Journal
American Journal of Respiratory and Critical Care Medicine
Published
2025-10-22
DOI
https://doi.org/10.1164/rccm.202508-2055st
Citations
1
Primary Topic
Tracheal and airway disorders
Type
article
Field-Weighted Citation Impact
1.52
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article

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

Karen Kam, Karen Watters, Jenny Shi, Narayan P. Iyer et al.
1 citations
American Journal of Respiratory and Critical Care Medicine
Tracheal and airway disorders
1.52
article

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

Karen Kam, Karen Watters, Jenny Shi, Narayan P. Iyer, Arwen Jackson, Nadia E Hoekstra, Fatima Zeba, Michael Brenner, David Zielinski, Robert J. Graham, Maria L. Castro‐Codesal, Natalie Napolitano, Karthik Balakrishnan, Shandra L. Knight, Cori Daines, Dan Benscoter, Joseph M. Collaco, Romaine F. Johnson, Evan J. Propst, An Thi Nhat Ho, Milenka Cuevas Guamán, Howard B. Panitch, Jackie Chiang, Amit Agarwal, Reshma Amin, Sheila S. Kun, Aaron St‐Laurent, Jeffrey D. Edwards, Jeremy D. Prager, M. Soma, Sarah A. Sobotka, J. Henningfeld, Ravi Kanth Velagapudi, Christopher D. Baker, Álvaro Pacheco, A. Ioana Cristea, Faiza Syed, Jessica A. Dawson
article en
1 citations

Abstract

<b>Background:</b> 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. <b>Methods:</b> 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). <b>Results:</b> 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). <b>Conclusions:</b> 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.

American Journal of Respiratory and Critical Care MedicineVol. 211(11)
University of North Carolina at Chapel Hill (US), Cincinnati Children's Hospital Medical Center (US), Boston Children's Hospital (US), Dartmouth–Hitchcock Medical Center (US), Lucile Packard Children's Hospital (US), Children's Hospital of Philadelphia (US), Children's Hospital of Los Angeles (US), University of Arizona (US), Johns Hopkins University (US), University of Alberta (CA), University of Toronto (CA), Medical College of Wisconsin (US), University of Michigan (US), Montreal Children's Hospital (CA), London Health Sciences Centre (CA), Hospital for Sick Children (CA), Saint Louis University Hospital (US), Alberta Children's Hospital (CA), University of Illinois Chicago (US), University of Chicago (US), Children's Hospital Colorado (US), Hospital Luis Calvo Mackenna (CL), Michigan Medicine (US), Sydney Children's Hospital (AU), Texas Children's Hospital (US), Center for Pain and the Brain (US), Stollery Children's Hospital (CA), Indiana University School of Medicine, University of Colorado Anschutz Medical Campus (US), Indiana University – Purdue University Indianapolis (US), Columbia University (US), The University of Texas Southwestern Medical Center (US), Michigan State University (US), University of Colorado Denver (US)
Openalex Percentile: Top 13%
Tracheal and airway disorders
1.52
DOISourceOpenAlex
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