Tracheostomy care and emergencies

Overview & Definition

A child with a tracheostomy who suddenly looks distressed, desaturates, and stops moving air is one of the most time-critical emergencies in paediatrics, because the airway that keeps them alive is a short plastic tube that can block or fall out in seconds. The reassuring truth is that almost every tracheostomy emergency comes down to two problems, a blocked tube or a displaced tube, and a simple, rehearsed algorithm resolves the great majority of them. The clinician who keeps that algorithm in mind, and who remembers to oxygenate both the face and the stoma, can rescue a child that an unfamiliar responder would lose. [1]

A tracheostomy is a surgically created opening through the anterior neck into the trachea, held open by a tube that bypasses the mouth, nose, pharynx, and larynx and delivers air directly to the lower airway. Children receive one for three broad reasons: to relieve upper airway obstruction, to provide long-term mechanical ventilation, and to allow safe pulmonary toilet in a child who cannot clear secretions. Increasingly, the paediatric tracheostomy patient is a medically complex, technology-dependent child who will live at home with the tube for years. [3]

Tracheostomy care spans the everyday and the catastrophic. Routine care means humidifying the inspired air the nose no longer warms, suctioning secretions, cleaning the stoma, and changing the tube on a schedule. Emergency care means recognising within seconds that the tube is blocked or out, working through a fixed sequence, and reinserting or removing the tube to restore a patent airway. Both halves are examinable, and both save lives. [4]

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1. [1]Doherty C Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies. Anaesthesia, 2018.PMID 30062783
2. [2]McGrath BA Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies. Anaesthesia, 2012.PMID 22731935
3. [3]Campisi P Pediatric tracheostomy. Seminars in Pediatric Surgery, 2016.PMID 27301607
4. [4]Fuller C Update on Pediatric Tracheostomy: Indications, Technique, Education, and Decannulation. Current Otorhinolaryngology Reports, 2021.PMID 33875932
5. [5]Komori M Update on pediatric tracheostomy. Auris Nasus Larynx, 2024.PMID 38520972
6. [6]Newton M Pediatric Tracheostomy-Related Complications: A Cross-sectional Analysis. Otolaryngology-Head and Neck Surgery, 2022.PMID 34520273
7. [7]Raynor T Pediatric tracheostomy decannulation: what's the evidence? Current Opinion in Otolaryngology and Head and Neck Surgery, 2023.PMID 37751378
8. [8]Xiao L Pediatric tracheostomy tube decannulation with or without polysomnography: A PRO-CON debate. Pediatric Pulmonology, 2022.PMID 34825785
9. [9]Kohn J Standardization of pediatric tracheostomy care with "Go-bags". International Journal of Pediatric Otorhinolaryngology, 2019.PMID 30913503
10. [10]Hebbar KB Mortality and Outcomes of Pediatric Tracheostomy Dependent Patients. Frontiers in Pediatrics, 2021.PMID 34017809
11. [11]Chorney SR Timing the First Pediatric Tracheostomy Tube Change: A Randomized Controlled Trial. Otolaryngology-Head and Neck Surgery, 2021.PMID 32928049
12. [12]De Jong R Pediatric Tracheostomy. StatPearls [Internet], 2026.PMID 32809457