Department of Paediatrics, Division of Respiratory Medicine, Children's Hospital-London Health Sciences Centre, London, Ontario, Canada.
Division of Pediatric Respirology, Department of Pediatrics, Montreal Children's Hospital/McGill University, Montreal, Quebec, Canada.
Pediatr Pulmonol. 2023 Jan;58(1):140-151. doi: 10.1002/ppul.26171. Epub 2022 Oct 11.
To describe the current clinical practice patterns of Canadian pediatric respirologists at pediatric tertiary care institutions regarding chronic tracheostomy tube care and management of home invasive ventilation.
A pediatric respirologist/pediatrician with expertise in tracheostomy tube care and home ventilation was identified at each Canadian pediatric tertiary care center to complete a 59-item survey of multiple choice and short answer questions. Domains assessed included tracheostomy tube care, caregiver competency and home monitoring, speaking valves, medical management of tracheostomy complications, decannulation, and long-term follow-up.
The response rate was 100% (17/17) with all Canadian tertiary care pediatric centers represented and heterogeneity of practice was observed in all domains assessed. For example, though most centers employ Bivona™ (17/17) and Shiley™ (15/17) tracheostomy tubes, variability was observed around tube change, re-use, and cleaning practices. Most centers require two trained caregivers (14/17) and recommend 24/7 eyes on care and oxygen saturation monitoring. Discharge with an emergency tracheostomy kit was universal (17/17). Considerable heterogeneity was observed in the timing and use of speaking valves and speech-language assessment. Inhaled anti-pseudomonal antibiotics are employed by most centers (16/17) though the indication, agent, and protocol varied by center. Though decannulation practices varied considerably, the requirement of upper airway patency was universally required to proceed with decannulation (17/17) independent of ongoing ventilatory support requirements.
Considerable variability in pediatric tracheostomy tube care practice exists across Canada. These results will serve as a starting point to standardize and evaluate tracheostomy tube care nationally.
描述加拿大儿科三级保健机构的儿科呼吸科医生在慢性气管造口管护理和家庭侵入性通气管理方面的当前临床实践模式。
在每个加拿大儿科三级保健中心确定一名在气管造口管护理和家庭通气方面具有专业知识的儿科呼吸科医生/儿科医生，以完成 59 项多项选择和简答题的调查。评估的领域包括气管造口管护理、护理人员能力和家庭监测、说话阀、气管造口并发症的医学管理、拔管和长期随访。
响应率为 100%（17/17），涵盖了所有加拿大三级保健儿科中心，并且在所有评估的领域都观察到了实践的异质性。例如，尽管大多数中心都使用 Bivona™（17/17）和 Shiley™（15/17）气管造口管，但在更换、重复使用和清洁实践方面存在差异。大多数中心需要两名受过培训的护理人员（14/17），并建议 24/7 对护理和血氧饱和度监测进行监督。配备紧急气管造口套件出院是普遍的（17/17）。在说话阀的使用和语音评估方面观察到相当大的异质性。大多数中心使用吸入性抗假单胞菌抗生素（16/17），尽管中心之间的适应证、药物和方案不同。尽管拔管实践存在很大差异，但拔管前普遍需要上呼吸道通畅（17/17），而无需考虑持续的通气支持要求。
加拿大各地的儿科气管造口管护理实践存在相当大的差异。这些结果将成为在全国范围内标准化和评估气管造口管护理的起点。
