Medical Management of Tracheostomy in the Child with Cerebral Palsy

Abstract

Patients with cerebral palsy (CP) may exhibit a variety of respiratory problems including abnormal muscle tone, restrictive lung disease, chronic respiratory failure, upper airway obstruction, swallow dysfunction, sleep disordered breathing, impaired cough, and/or difficulty clearing respiratory secretions. Tracheostomy tube placement may be considered in select patients with CP in the setting of severe illness or chronic, recurrent respiratory symptoms that are progressively worsening, and/or the need for escalating support over time. Common benefits of tracheostomy placement include providing a stable airway, and ensuring a pathway for adequate oxygenation and ventilation in addition to pulmonary toilet. However, tracheostomies are not without consequences and insufficient monitoring or lack of vigilant care can be life-threatening. Common complications following tracheostomy tube placement may include tracheal obstruction from mucus plugging, accidental dislodgement, granulation tissue formation, bleeding, or acute infection such as tracheitis. The decision to pursue tracheostomy placement requires careful consideration, medical knowledge of the risks and benefits of such a procedure, and candid discussion with caregivers about the lifestyle changes and extensive acute and chronic care and monitoring that is required following placement. Tracheostomy placement in patients with CP is typically permanent, with very rare cases of patients who are able to tolerate tracheal decannulation (removal). This chapter reviews the indications and testing available for patients in whom tracheostomy placement is being considered and in whom decannulation may be a rare possibility.