Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies

Abstract

Summary Temporary and permanent tracheostomies are required in children to manage actual or anticipated long‐term ventilatory support, to aid secretion management or to manage fixed upper airway obstruction. Tracheostomies may be required from the first few moments of life, with the majority performed in children < 4 years of age. Although similarities with adult tracheostomies are apparent, there are key differences when managing the routine and emergency care of children with tracheostomies. The National Tracheostomy Safety Project identified the need for structured guidelines to aid multidisciplinary clinical decision making during paediatric tracheostomy emergencies. These guidelines describe the development of a bespoke emergency management algorithm and supporting resources. Our aim is to reduce the frequency, nature and severity of paediatric tracheostomy emergencies through preparation and education of staff, parents, carers and patients.

Surgical tracheostomy in children with malignancy receiving intensive chemotherapy: A case series and review of literature

“…Although our series is a retrospective review of a small number of patients in a single centre, we are not aware of any literature describing complications and outcome of tracheostomy in children receiving intensive chemotherapy for haemato‐oncological malignancy. Tracheostomy care in children is complex and high risk with potential for preventable adverse events that could be life threatening and requires multidisciplinary expertise with guideline‐driven care involving patient, family and carer to achieve optimum outcome . This is provided by a dedicated paediatric tracheostomy service in our institution.…”

“…Tracheostomy care in children is complex and high risk with potential for preventable adverse events that could be life threatening and requires multidisciplinary expertise with guideline-driven care involving patient, family and carer to achieve optimum outcome. 10 This is provided by a dedicated paediatric tracheostomy service in our institution.…”

An innovative collaborative interdisciplinary approach to new paediatric tracheostomy safety guidelines

“…This would not have occurred if the initial architects of MEPA had embarked on developing a course only for their own institution. Before the development of the Multidisciplinary Emergency Paediatric Tracheostomy Guidelines , we had individual institutions developing their own guidelines, educational interventions and training packages. The global collaborative nature of this paediatric tracheostomy guideline development is a hugely significant step, in terms of both quality assurance and possibilities for quality improvement.…”

“…Recognising the above factors, the authors set about developing multidisciplinary guidelines for the management of paediatric tracheostomy emergencies. The paediatric guidelines retain the core principles of provision of emergency oxygenation and limiting unnecessary airway interventions from the previously developed adult guidelines promulgated by the Difficult Airway Society and the NTSP . However, upon forming the Paediatric NTSP National Working Party in 2013, the authors went about producing the current set of paediatric emergency tracheostomy tube care guidelines with a rigorous methodology.…”

“…With this underlying environment, development of standardised treatment plans, transferable between hospitals and locations in which children with tracheostomies are managed, can be considered as valuable as cardiopulmonary resuscitation algorithms . The authors in this paper have strived to produce just this sort of guidance for paediatric tracheostomy care .…”