PT  - JOURNAL ARTICLE
AU  - Teresa A Volsko
AU  - Sara W Parker
AU  - Kathleen Deakins
AU  - Brian K Walsh
AU  - Katherine L Fedor
AU  - Taher Valika
AU  - Emily Ginier
AU  - Shawna L Strickland
TI  - AARC Clinical Practice Guideline: Management of Pediatric Patients With Tracheostomy in the Acute Care Setting
AID  - 10.4187/respcare.08137
DP  - 2021 Jan 01
TA  - Respiratory Care
PG  - 144--155
VI  - 66
IP  - 1
4099  - http://rc.rcjournal.com/content/66/1/144.short
4100  - http://rc.rcjournal.com/content/66/1/144.full
AB  - Children requiring a tracheostomy to maintain airway patency or to facilitate long-term mechanical ventilatory support require comprehensive care and committed, trained, direct caregivers to manage their complex needs safely. These guidelines were developed from a comprehensive review of the literature to provide guidance for the selection of the type of tracheostomy tube (cuffed vs uncuffed), use of communication devices, implementation of daily care bundles, timing of first tracheostomy change, type of humidification used (active vs passive), timing of oral feedings, care coordination, and routine cleaning. Cuffed tracheostomy tubes should only be used for positive-pressure ventilation or to prevent aspiration. Manufacturer guidelines should be followed for cuff management and tracheostomy tube hygiene. Daily care bundles, skin care, and the use of moisture-wicking materials reduce device-associated complications. Tracheostomy tubes may be safely changed at postoperative day 3, and they should be changed with some regularity (at a minimum of every 1–2 weeks) as well as on an as-needed basis, such as when an obstruction within the lumen occurs. Care coordination can reduce length of hospital and ICU stay. Published evidence is insufficient to support recommendations for a specific device to humidify the inspired gas, the use of a communication device, or timing for the initiation of feedings.