Question

Paediatric tracheostomy.

Hint:

Paediatric tracheostomy is a critical procedure for children with severe airway obstruction or respiratory failure, but it requires ongoing care and management to avoid complications and ensure optimal outcomes.

Answer 1

Step 1: Indications for Paediatric Tracheostomy:
Paediatric tracheostomy is a surgical procedure to create an opening in the trachea for the placement of a tube to provide an airway for children with respiratory difficulties. Indications include:
1. Airway Obstruction: Severe congenital or acquired airway anomalies (e.g., laryngomalacia, tracheal stenosis) that cause chronic airway obstruction and respiratory distress.
2. Prolonged Ventilation Needs: Children requiring long-term mechanical ventilation due to conditions like neuromuscular disorders, brain injury, or congenital heart defects.
3. Obstructive Sleep Apnea: Severe cases of obstructive sleep apnea that do not respond to non-invasive treatment.
4. Severe Aspiration: Children with impaired swallowing and recurrent aspiration leading to respiratory infections.

Step 2: Surgical Procedure and Considerations:
1. Surgical Approach: The procedure is typically performed under general anesthesia and involves making an incision in the lower part of the neck to expose the trachea. The tracheostomy tube is inserted through the trachea to establish an airway.
2. Age-Specific Considerations: In infants and young children, the procedure requires special attention to the size and type of tracheostomy tube, as well as the potential for complications like tube dislodgement and accidental decannulation.
3. Complications: Potential complications include infection, bleeding, airway injury, and long-term issues such as tracheal stenosis or tracheomalacia.

Step 3: Post-Operative Care:
1. Monitoring: Close monitoring in an intensive care unit (ICU) or pediatric ward is essential after surgery to ensure the child maintains a stable airway and prevent complications such as tube displacement or infection.
2. Tracheostomy Care: Regular cleaning and maintenance of the tracheostomy tube are critical to avoid infections and blockages. Parents and caregivers must be trained to care for the tracheostomy tube.
3. Speech and Swallowing Therapy: Depending on the underlying condition, speech therapy may be necessary to help the child with speech and swallowing after tracheostomy.