Management of Pediatric Patients With Tracheostomy in the Acute Care Setting

Publication Date: January 1, 2021
Last Updated: March 14, 2022

Recommendations

Cuffed tracheostomy tubes should only be used if requiring positivepressure ventilation or preventing aspiration (Evidence level C).
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Manufacturer guidelines should be followed for cuff management (Evidence level C).
6731

There are no suggestions for the use or non-use of a speaking valve to reduce device-associated complications, facilitate developmental milestones, and minimize ICU and hospital readmissions.
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A daily care bundle is supported to reduce device-associated complications (Evidence level B; appropriateness score median 8, range 8–9).
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Low-level evidence supports changing a tracheostomy tube at postoperative day 3 in pediatric patients without a risk of increased complications (Evidence level B; appropriateness score median 8; range 5–9).
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There are no suggestions for the type of humidification used for hospitalized pediatric patients to reduce device-associated complications, facilitate developmental milestones, and minimize ICU and hospital readmission.
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Expert experience of the committee supports regular tracheostomy tube hygiene according to manufacturer’s recommendations to prevent mucus plugging resulting in airway obstruction and infection (Evidence level C).
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A moisture-wicking material placed under the tracheostomy tube is recommended to help keep the skin dry (Evidence level B; appropriateness score median 8; range 8–9).
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Skin of the neck should be cleansed, and moisture-wicking material should be changed daily (Evidence level B; appropriateness score median 8; range 8–9).
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Tracheostomy tubes should be changed as needed secondary to obstruction, and with some regularity at a minimum of 1–2 weeks (Evidence level B; appropriateness score median 7; range 6–9).
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Low-level evidence supports care coordination to reduce hospital and ICU stay (Evidence level B; appropriateness score median 8; range 8–9).
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There are no suggestions for the timing of oral feeding in hospitalized infants and children requiring a tracheostomy tube.
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Grading Table
Evidence Levels Likert Scale (1–9) (Harm vs. Benefit)
A Strong All votes ≥7
B Weak Any vote <7
C Expert opinion

Recommendation Grading

Overview

Title

Management of Pediatric Patients With Tracheostomy in the Acute Care Setting

Authoring Organization

Publication Month/Year

January 1, 2021

Last Updated Month/Year

February 7, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Male, Female, Child, Infant

Health Care Settings

Ambulatory, Emergency care, Hospital

Intended Users

Nurse, nurse practitioner, physician, physician assistant, respiratory therapist

Scope

Management

Diseases/Conditions (MeSH)

D014139 - Tracheostomy

Keywords

pediatric, tracheostomy, pediatrics, pressure injury, tracheostomy tube, intracuff pressure, , tracheostomy care

Source Citation

Volsko TA, Parker SW, Deakins K, Walsh BK, Fedor KL, Valika T, Ginier E, Strickland SL. AARC Clinical Practice Guideline: Management of Pediatric Patients With Tracheostomy in the Acute Care Setting. Respir Care. 2021 Jan;66(1):144-155. doi: 10.4187/respcare.08137. PMID: 33380501.

Supplemental Methodology Resources

Data Supplement