Care of the patient with a tracheotomy

Case presentation P.F. is a 25-year-old man with a history of congenital central hypoventilation syndrome and a left hypoplastic lung, which was later resected secondary to recurrent infections. He has undergone chronic nocturnal ventilation since he was 6 months of age. During the day, he caps his tracheotomy and keeps his cuff deflated. At night, he uses volume ventilation and a heat and moisture exchange (HME) humidification system. Recently, he was admitted to hospital for pneumonia. His oxygen requirement was increased but he was comfortable off the ventilator during the day so his home routine was continued. Should his home routine be maintained? What problems might be encountered? What are the options of care? Are there evidence-based data to support the therapeutic decisions? To answer the questions regarding this patient’s care, one has to understand issues normally encountered with a chronic tracheotomy. The initial and continued reason for the tracheotomy will determine some of the monitoring issues. The need for continuous ventilation does not necessarily change the problem list, but rather it may expand it. Key issues for the chronic tracheotomy patient include secretions and their control, humidification, tracheotomy site care, and proper tracheotomy tube fitting. The patient will encounter different needs from home to hospital and these will vary depending on the reason for the tracheotomy. Speaking and swallowing with a tracheotomy are covered in another section.