Guideline Video

Guideline Resources

  • Title: Care of Infants and Children With Tracheostomies
  • Society: American Thoracic Society
  • Publish Date: October 22, 2025
  • Summary
  • Pocket Guide
  • Full-text

Video Transcription

Just published October 22nd, 2025 - The American Thoracic Society’s newest guideline on Care of Infants and Children with Tracheostomies.

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.

There are 6 recommendations so let’s get started. 

  • The guideline recommends applying ethical principles (beneficence, nonmaleficence, autonomy, and justice) to guide shared decision-making about tracheostomy placement.
  • The guideline suggests implementing a standardized discharge process to facilitate the safe transition of tracheostomy-dependent children from hospital-to-home. 
  • The guideline recommends that an awake and alert trained caregiver always be present with children at risk of immediate decompensation due to tracheostomy-related complications. 
  • In well children with tracheostomy tubes, the guideline suggests against routine surveillance of tracheal aspirates for bacterial growth. 
  • In children with tracheostomy tubes and concerns for lower respiratory tract infection, the guideline suggests culturing tracheal aspirate when needed to guide management. 
  • In children with tracheostomy tubes who were recently treated with antibiotics and are clinically improving, the guideline suggests against “test of cure” tracheal aspirates. 
  • For children with tracheostomies, the guideline suggests performing an endoscopic airway evaluation in those with a change in symptoms, or with persistent symptoms unresponsive to medical management. 
  • For children with tracheostomies, the guideline recommends performing a complete airway evaluation prior to a decannulation attempt. Airway evaluation should include an assessment of nose and nasopharynx, oropharynx and oral cavity, supraglottis and larynx, and subglottis, trachea and bronchi.
  • The guideline suggests that, in addition to a formal airway evaluation, either a polysomnogram or pulse oximetry study under direct observation with a capped tracheostomy be performed as part of the evaluation for decannulation readiness. 
  • The guideline suggests polysomnography with a capped tracheostomy (or occluded stoma) in the following situations: assessing transition readiness from invasive to non-invasive ventilation, unclear cause of failed capping trials, for patients with medical and/or airway complexity. 

And there you have it. Make sure to check out the full guideline from American Thoracic Society and other related clinical decision support tools at guideline central.com.

Copyright © 2025 Guideline Central, all rights reserved.