1. Increased respiratory secretions and airway obstruction
Airway obstruction is the most critical and life-threatening event that can occur in patients with a tracheostomy tube or on home mechanical ventilation. Immediate and effective action is crucial to clear the airway obstruction to prevent the development of hypoxemia, which is a condition characterized by low oxygen levels in the blood. Even a slight contamination of small cannulas used in children can cause a significant increase in airway resistance, as the smaller the inside diameter of the cannula, the greater the risk of airway obstruction by secretions.
A tracheostomy tube, while necessary for respiratory support, bypasses the natural protective mechanisms of the nose and oral cavity, such as ciliary clearance, filtration, humidification and warming of the inhaled air. Consequently, children with a tracheostomy may encounter an array of respiratory challenges, including an increased likelihood of cough, susceptibility to pulmonary infections, and dryness of pulmonary secretions. To safeguard the airways from irritation caused by dry air, dust, or harmful particles present in the environment, the use of appropriate filters becomes indispensable. Equally vital is the implementation of humidification and frequent suctioning, essential measures aimed at reducing the risk of crust formation, mucus plugs, and potential tube blockages. By adhering to these meticulous care practices, we can ensure optimal airway health and enhance the overall well-being of children reliant on tracheostomy tubes for long-term respiratory support 6. This vulnerable population, emergencies related to the tracheostomy cannula occur more frequently compared to adults, with accidental removal of the cannula and aspiration being particularly prevalent. When encountering symptoms such as fever, increased secretions, persistent cough, dyspnea, and exhaustive forced breathing, close monitoring is essential to identify potential complications. In such cases, employing pulse oximetry during spontaneous inhalation of ambient air aids in timely intervention and ensures adequate oxygenation for these young patients7. In patients requiring HIMV with ineffective cough and/or neuromuscular disease with poor respiratory muscle strength can be used a mechanical insufflation–exsufflation device to help maintain airway clearance. Despite advanced home monitoring systems, almost 20% of the overall mortality rate are attributed to preventable deaths related to tracheostomy accidents that like accidental decannulation and mucous plugging of the tracheostomy tube 1. In such situations, one of the caregivers must always be awake and promptly remove the obstruction using an aspiration device. Ensuring the patient receives adequate oxygenation is crucial during this critical time.
According to the latest Canadian research study at a tertiary care center that involved pediatric respiratory specialists and pediatricians with specialist in tracheostomy tube care and home ventilation; in patients experiencing excessive oral secretions, medical centers accept a range of effective strategies for management. Among the approaches; salivary gland botox injection, nutritional assessment, gastrostomy feeding, humidifier thorough tracheal masks, enteral glycopyrrolate administration, salivary gland duct ligation, and scopolamine patches8.