Management of Pediatric Patients With Tracheostomy in the Acute Care Setting
Publication Date: December 31, 2020
Last Updated: March 14, 2022
Recommendations
Cuffed tracheostomy tubes should only be used if requiring positivepressure ventilation or preventing aspiration (Evidence level C).
6731
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.
6731
A daily care bundle is supported to reduce device-associated complications (Evidence level B; appropriateness score median 8, range 8–9).
6731
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).
6731
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.
6731
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).
6731
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).
6731
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).
6731
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).
6731
Low-level evidence supports care coordination to reduce hospital and ICU stay (Evidence level B; appropriateness score median 8; range 8–9).
6731
There are no suggestions for the timing of oral feeding in hospitalized infants and children requiring a tracheostomy tube.
6731
Having trouble viewing table?
| 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
American Association for Respiratory Care
Publication Month/Year
December 31, 2020
Last Updated Month/Year
August 30, 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.