Chest
Clinical Investigations: Inflammation/InfectionSuspected Respiratory Tract Infection in the Tracheostomized Child: The Pediatric Pulmonologist's Approach
Section snippets
Questionnaire Distribution
A three-page questionnaire was mailed early in 1994, along with a self-addressed, stamped envelope to the directors of the 46 accredited pediatric pulmonology fellowship programs listed in the January 1993 issue of Journal of Pediatrics and/or the October 1993 issue of the American Review of Respiratory Disease.8,9 An accompanying cover letter was sent, describing the survey, and our desire to assess the “standard of care” regarding management of children with tracheostomies at different
Responses
Completed questionnaires were returned by 34 centers (72% response rate), 4 of which desired to remain anonymous. Five questionnaires were completed by nurses or respiratory therapists; the rest were completed by physicians. Not all questionnaires that were returned contained responses to every question; when the number of responders to a question was <34, it is indicated below.
Center and Patient Characteristics
Respondents completing the questionnaire as center representatives (referred to in this “Results” section as
DISCUSSION
The survey results show that pediatric pulmonologists do not generally follow a formal protocol to guide management of possible respiratory tract infections in tracheostomized children; most center representatives (hereafter referred to as “centers”) vary their approach based on the patient's underlying diagnosis. Most centers obtain a tracheal aspirate for culture and sensitivity analysis if there has been a change in usual secretions, even in a well patient; secretions becoming green was
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Cited by (26)
Microbiology and management of respiratory infections in children with tracheostomy
2023, Paediatric Respiratory ReviewsRepublication of: Tracheostomized children tracheal colonization and antibiotic resistance profile - A STROBE analysis
2023, Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-FacialeTracheostomized children tracheal colonization and antibiotic resistance profile – A STROBE analysis
2023, European Annals of Otorhinolaryngology, Head and Neck DiseasesCitation Excerpt :Rusakow et al. (1998) showed that pediatric pneumologists more frequently would perform tracheal secretion cultures if the secretion color was green, had foul smell or the patient had fever or signs of sepsis. Also, they more frequently would treat the culture results as an infection if it had many white blood cells on Gram stain, if the patient had signs of respiratory illness or changes in the secretion usual baseline [21]. In our study, all tracheal aspirates were performed during routine care of tracheostomized patients and not due to signs of infection, however, it was not the aim of this study to analyze infection or the treatment of tracheal colonization.
The effect of nebulized antibiotics in children with tracheostomy
2021, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :Children with tracheostomy have an increased risk of bacterial colonization and persistent infection of the lower respiratory tract [1]. Tracheostomy bypasses the defensive mechanisms of the upper respiratory system, including filtering and removing the microorganisms via mucociliary transport and cough [1]. In patients with tracheostomy, altered anatomy and recurrent suctioning may lead to chronic colonization and subsequent infections [2].
Respiratory tract infections in children with tracheostomy
2020, Journal of Microbiology, Immunology and InfectionCitation Excerpt :This suggests that NTM infections in children with tracheostomy are difficult to eradicate. To date, no published guidelines for the diagnosis and management of respiratory infections in tracheostomized pediatric patients are available.8,14 In addition, no expert consensus exists on the signs and symptoms that indicate bacterial respiratory infections in this population, causing clinicians to initiate antibiotics when patients reveal particular signs and symptoms.
Children Dependent on Respiratory Technology
2019, Kendig's Disorders of the Respiratory Tract in Children