Aims To present our experience of managing children with a tracheostomy in a Multi-Disciplinary Team clinic consisting of an ENT Consultant, Paediatric Respiratory Consultant, a Nurse Specialist and Speech and Language Therapist.
Methods Retrospective case note review of all children seen in the Multi-Disciplinary Team Tracheostomy clinic between February 2009 and May 2011. Data analysed to determine the current underlying indication for tracheostomy and the number of tracheostomy related issues managed per clinical episode.
Results The MDT Tracheostomy clinic began in February 2009 and is held once a month. 44 different patients have been seen in 81 outpatient episodes between February 2009 and May 2011. In our series the three most common indications for tracheostomy were; underlying neurodevelopmental problems (61.3%, n = 27), most commonly cerebral palsy (43.2%, n = 9), lower airway problems (59%, n = 26) and upper airway obstruction (including subglottic stenosis, n = 7) (59%, n = 26). 15 patients were on ventilators with a further 6 patients who had had previously been on long term ventilation. The median number of tracheostomy related issues dealt with each appointment was 1 (range 0 – 4). Secretions were the most common problem (51.7% of visits). 40% (n = 6) patients on a ventilator had ventilator issues reviewed. 14 patients had a speaking valve already and 10 were considered for a trial of a speaking valve.
Conclusions Children with a tracheostomy are a diverse group of patients. The most common indications for paediatric tracheostomy have changed in the last 50 years from infective causes to airway obstruction and anomalies, long-term ventilation requirement and underlying neuromuscular or respiratory problems. Our approach to managing this diverse group of patients involves a Multi-Disciplinary Team consisting of a Paediatric Otolaryngology Consultant, a Paediatric Respiratory Physician and a Tracheostomy Nurse Specialist or Speech and Language Therapist (SALT). The unified approach also empowers the carers and patient as a home management plan, long-term plan and goals are generated at the end of each appointment.