The Tracheostomy Decision with Dr. Parisa Kaviany and Dr. Maria Arroyo--Part 2
Dec 5, 2022
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Two expert pulmonologists discuss the intricate decision-making process surrounding tracheostomies in children. They delve into the essential support systems for families transitioning from hospital to home care. Topics include oxygen management, the pivotal role of respiratory therapists, and the necessity of emergency preparedness. They also highlight valuable resources designed to assist families, emphasizing personalized care and effective communication in navigating these challenging circumstances.
19:24
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Quick takeaways
Effective communication with families about expectations and equipment needs is critical for the safe transition home post-tracheostomy.
Post-discharge follow-up care and support systems, including telemedicine and respiratory therapists, are essential for managing patients' ongoing respiratory stability at home.
Deep dives
Expectations for Tracheostomy Patients Post-ICU
Successfully transitioning patients with new tracheostomies home requires clear communication of expectations to both the patients and their families. Key considerations include establishing baseline settings that allow patients to engage in physical therapy and day-to-day activities without major incidents. It is vital for medical professionals to assess each patient's tolerance to these activities before discharge, helping to ensure they can maintain respiratory stability and manage their own care effectively once at home. Families should receive guidance on the necessary equipment and interventions, including the impact of oxygen dependency on quality of life during transport.
Importance of Follow-Up Care
Post-discharge follow-up care is crucial for patients with tracheostomies and ventilator support to ensure ongoing stability and troubleshoot potential issues. Typically, follow-up appointments occur four to eight weeks after discharge, with the recommendation for families to connect with a complex care pediatrician familiar with their child's history. The use of telemedicine has emerged as an effective means for follow-up care, allowing providers to check in with patients and guide parents in managing complex equipment from home. Empowering families with knowledge about their child's care, along with access to pediatric pulmonology, enhances their ability to address concerns promptly.
Role of Support Systems and Resources
Support systems, including respiratory therapists, play a vital role in preparing families for home care by providing training and technical assistance with equipment. Parents should have an emergency kit readily available and learn how to troubleshoot common issues tied to the patient's tracheostomy and ventilation. Resources like Family Reflections and the American Thoracic Society offer essential information for families, helping them navigate life with a tracheostomy. Additionally, sharing tips from other parents, such as using mobility aids for a child with a ventilator, can significantly improve the quality of life for families managing these complex situations.
Dr. Parisa Kaviany is a former Children’s National Resident, she completed her pediatric pulmonology fellowship at Johns Hopkins and we were lucky enough to get her back as a pulmonologist. Dr. Kaviany’s research interest is health disparities among children with asthma.
Dr. Maria Arroyo did her pulmonology fellowship at Children’s National in DC and stayed as an attending, she also works at The HSC Pediatric Center, a subacute care facility in Washington, DC. Dr. Arroyo is THE person you want your patients’ parents to meet when they’re making the tracheostomy decision.
Objectives: By the end of listening to this episode, learners should be able to:
Describe the typical stakeholders involved in a tracheostomy decision.
Understand the caregiver, spatial, and technical requirements of living at home with a tracheostomy.
Describe the requirements that must be met prior to discharge to an acute care facility.
Differentiate the ventilator weans that must take place prior to discharge home vs prior to discharge to an acute care facility.
Mentioned in this episode: Family Reflections: a website about deciding about home ventilation ATS Trach Education PDF: A pediatric tracheostomy education PDF from the American Thoracic Society Lilly's little lungs: one family's story of going home with a preemie who needs a trach and vent, the account follows her through a successful LTR.
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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
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