需要气管造口术以维持气道通畅或促进长期机械通气支持的儿童需要全面的护理和承诺,受过训练,指导护理人员安全地管理他们复杂的需求。这些指南是根据对文献的全面回顾而制定的,目的是为选择气管切开导管的类型(袖口式和无袖口式)提供指导。使用通信设备,实施日常护理捆绑,第一次气管造口术改变的时机,使用的加湿类型(主动与被动),口服喂养的时间安排,护理协调,和常规清洁。袖口气管造口管只能用于正压通气或防止误吸。对于袖带管理和气管造口管卫生,应遵循制造商指南。日常护理捆绑包,护肤,和吸湿材料的使用减少了装置相关的并发症。术后第3天可以安全更换气管造口管,并且应定期更换(至少每1-2周)以及根据需要更换,例如当管腔内发生阻塞时。护理协调可以减少住院时间和ICU住院时间。已发布的证据不足以支持对吸入气体进行加湿的特定设备的建议,使用通信设备,或开始喂食的时机。
Children requiring a tracheostomy to maintain airway patency or to facilitate long-term mechanical ventilatory support require comprehensive care and committed, trained, direct caregivers to manage their complex needs safely. These
guidelines were developed from a comprehensive review of the literature to provide guidance for the selection of the type of tracheostomy tube (cuffed vs uncuffed), use of communication devices, implementation of daily care bundles, timing of first tracheostomy change, type of humidification used (active vs passive), timing of oral feedings, care coordination, and routine cleaning. Cuffed tracheostomy tubes should only be used for positive-pressure ventilation or to prevent aspiration. Manufacturer
guidelines should be followed for cuff management and tracheostomy tube hygiene. Daily care bundles, skin care, and the use of moisture-wicking materials reduce device-associated complications. Tracheostomy tubes may be safely changed at postoperative day 3, and they should be changed with some regularity (at a minimum of every 1-2 weeks) as well as on an as-needed basis, such as when an obstruction within the lumen occurs. Care coordination can reduce length of hospital and ICU stay. Published evidence is insufficient to support recommendations for a specific device to humidify the inspired gas, the use of a communication device, or timing for the initiation of feedings.