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Trachs & Vents > Pediatric Considerations > Flashcards

Pediatric Considerations Flashcards

1
Q

Incidence of trachs in the pediatric population

A

~4,861 trachs performed each year – > 1/2 of those are children between birth & 11 months

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2
Q

Indications for trach in pediatric population

A
  • Providing access for prolonged ventilation
  • Bypassing airway obstruction
  • Subglottic stenosis
  • Facilitating tracheobronchial toilet
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3
Q

Common diagnosis that result in peds w/trachs

A
  • Prematurity
  • Pierre Robin Syndrome, Bronchopulmonary Dysplasia (BPD), Tracheomalacia, Spinal bifida, Muscular dystrophy, Cystic fibrosis, Craniofacial abnormalities
  • Accidents, abuse, trauma
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4
Q

Pierre Robin Syndrome

A
  • Congenital, infant has a smaller than normal lower jaw, a tongue that falls back in the throat, and difficulty breathing
  • Aspiration is a common risk w/this population
  • Severe cases may require a trach
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5
Q

Bronchopulmonary Dysplasia (BPD)

A
  • Chronic lung condition that affects newborn babies who were either put on a breathing machine after birth or were born very early
  • risk factor: severe respiratory or lung infection
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6
Q

Symptoms of bronchopulmonary dysplasia

A
  • Bluish skin color
  • Chronic cough
  • Rapid breathing
  • Shortness of breath
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7
Q

Signs/tests for bronchopulmonary dysplasia

A
  • Arterial blood gas
  • Chest CT scan
  • Chest x-ray
  • Pulse oximetry
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8
Q

Bronchopulmonary dysplasia treatment (in the hospital)

A
  • Vent required to send pressure to lungs to keep them inflated & deliver more oxygen
  • Pressure & oxygen slowly reduced - weaned from vent but may need mask or nasal cannula
  • Usually fed by NG tubes
  • Need extra calories due to effort of breathing
  • May need to limit fluids or use diuretics to keep lungs from filling w/fluid
  • Medications: corticosteroids, bronchodilators, surfactants
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9
Q

Bronchopulmonary dysplasia treatment (at home)

A
  • May need oxygen therapy for weeks/months after leaving hospital
  • Need to receive enough calories
  • May need tube feeds / special formulas
  • Prevent child from getting colds / other respiratory infections (respiratory RSV virus)
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10
Q

Do preterm infants stop breathing because of swallowing?

A

NO

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11
Q

What is the most frequent swallow & respiration pattern with preterm infants?

A

Inspiration –> swallow –> expiration

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12
Q

Do infants with bronchopulmonary dysphasia often demonstrate sucking difficulties?

A

YES

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13
Q

What do you need to evaluate with infants with bronchopulmonary dysplasia?

A
  • Suck –> swallow –> breath

- Sucking endurance

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14
Q

Literature on swallowing in infants suggest that the movement of the supra glottis structures during the act of bolus swallowing is _____ and tends to be ____________ in young children w/ long term trachs

A

slower; more restrictive

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15
Q

__% of pediatric patients with a trach had swallowing problems. (Arvedson & Brodsky – Rosingh & Peek)

A

48% (A & B)
*Many of these patients also had an underlying neurophysiological factor that may be affecting the swallow
91% (R & P)

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16
Q

Marianjoy Pediatric Study: Was there a difference between the acquired group and the congenital group?

A

Nope

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17
Q

Marianjoy Pediatric Study: Aspirators were significantly ____ than the non-aspirators

A

OLDER (10 y/o vs. 3 y/o)

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18
Q

What do you use for clinical swallow evaluations of infants?

A

Formula

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19
Q

What do you use for clinical swallow evaluations of older children?

A

Use age appropriate / developmentally appropriate foods

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20
Q

Can you use blue food coloring during CSE with infants?

A

NO - their digestive system probably is not able to handle blue dye foods

21
Q

Can you use blue food coloring during CSE with older children?

A

MAYBE - blue popsicles, suckers, kool-aide, yogurt, etc.

*Many children have a sensitivity to “blue” foods - need to be careful

22
Q

May be able to gather some information during the CSE that will…

A

Help direct your instrumental examination, determine appropriate timing for an instrumental examination with this patient, radiation exposure / FEES tolerance

23
Q

The inability to palpate laryngeal movement with young child or infants with a trach during a CSE may warrant _______________.

A

An instrumental examination of the swallow.

24
Q

Specific deficits to rule out during a VFSS include: (3)

A
  • Slowing of laryngeal vestibule closure
  • Reduced laryngeal excursion
  • Airway contamination / penetration / aspiration
25
Q

Airway / Secretions -all 50 patients presented with ….

A

Secretion management issues

26
Q

__% had reduced secretion management issues at the level of the trachea.

A

98%

27
Q

__% had problems with oral secretion management.

A

56%

28
Q

__% showed reduced secretion management at the level of the larynx.

A

40%

29
Q

Are excessive secretions with this patient population extremely common?

A

Yes

30
Q

Management of secretions of ____ and ____ _____ are critical to maintaining _________________.

A

Upper & lower airway; pulmonary health

31
Q

Are frequent infections common with the pediatric population?

A

YES

32
Q

__% of peds with a trach were able to tolerate the one-way valve

A

49%

33
Q

The peds that were able to tolerate the one-way valve demonstrated improvement with ________________ at the oral cavity, larynx, and/or trachea

A

secretion management

34
Q

Airway Protective Responses: __% displayed problems with airway protection responses

A

90%

  • Did not elicit a reflexive cough to clear
  • Had a delayed cough
  • Only coughed when suctioned
35
Q

VFSS / FEES special considerations (3)

A
  • Radiation exposure (timing of VFSS)
  • Oral spillage of barium
  • Accidental spillage from cup (trach tube hub - artificial nose / trach vent covering - trach ties becoming saturated)
36
Q

If a ped w/a trach is medically stable, is it likely that they can swallow safely?

A

Yes!

37
Q

__% of infants who require mechanical ventilation via trach tube did NOT aspirate during VFSS or FEES

A

93%

38
Q

Medically table / good prognostic factors: (3)

A
  • Improving physical condition
  • Stable ventilator setting for 7-14 days
  • Ongoing tachypnea w/respiratory rate of 40 to 50 breaths per minute
39
Q

PMV may be used as young as _________.

A

13 DAYS old

40
Q

PMV is better to be used as early as possible because:

A
  • Communication development / speech production (cooing, crying, vocal play, more normal socialization for the infant)
  • may use play/trust environment (trach dino) and distraction
41
Q

Pediatrics with a trach tube has a _______ ______ of airway abnormality as compared to adults.

A

larger %

42
Q

Most pediatric trachs are …

A

cuffless

43
Q

Patient selection: their airways are much smaller so you need to make sure of what..?

A

Need to insure properly sized trach tube in place and that the patient has a patent upper airway with the use of a one-way valve

44
Q

Premature infants in the NICU may be ______ with ____________.

A

Ventilated; high pressure

45
Q

Premature infants in the NICU may have difficulty … (2)

A

maintaining ventilation / compensating for the leak of air out of the mouth when downsizing the trach or deflating the cuff in order to use the PMV in-line with the ventilator

46
Q

Team members for pediatrics w/trachs

A
  • Physician
  • Respiratory Therapist
  • SLP
  • OT
  • PT
  • Child life specialist
  • Child & Family
47
Q

__% of peds with trachs were able to tolerate the PMV

A

83%

48
Q

__% of the children who are able to tolerate the PMV were able to vocalize on the first valve trial
****

A

75%

Trachs & Vents (3 decks)

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