Peds Resp Trach Issues

[JanetCCURN]

I have a lil pt who was a 24 weeker, trached, gt with fundoplication. Now he is approx 6mo chronological and 12lbs. His trach size was changed from a 3.0 Neo to 3.5 Peds. He makes these raspy forced sounds. His lungs are clear, pulse ox 95-98 on 1/16L/min O2. If when I suction, nothing comes out. When he settles back down, his sounds are completely clear and easy flowing. He doesn't look distressed, I just cannot pinpoint what is going on. His pulmonologist has heard the sounds during visits according to mom and has not made any note of it or any changes to his care. What could this be????

[Pedi-Gree, BSN, RN]

That's really not that uncommon. When kids with trachs are awake and active, they have more secretions, but not necessarily enough to suction up. The 3.5 peds trach tube is about 10 mm longer than the neo 3.0 so it may be a teensy bit close to the carina. He doesn't appear to be compromised by these noisy resps, and the ENT isn't worried, so I wouldn't be. BUt I definitely would ask about it the next time the ENT comes around.

[dander625]

Hi,

My twins were born prematurely (31 weeks, both intubated in the NICU) and when they came home one of my sons had the same sound when he drank from his bottle and sometimes when he was asleep. His pediatrician said it was called tracheomalacia(sp?) and explained to me that the cartilage in his windpipe was soft and that by his first birthday the cartilage would mature and the raspy sounds would disappear. Sure enough, she was right! Don't know if this explains the sounds in your little 24 weeker, but thought I'd mention it as a possibility.

[Pedi-Gree, BSN, RN]

Tracheomalacia is fairly common in kids who have either been intubated or trached for a lengthy period, although some kids are born with it. It's related to the presence of a foreign body in the airway and the constant pressure at the proximal end. Malacia means softening, and that's what happens to the tissue in the trachea. It softens and becomes floppy. Most kids will outgrow it eventually but until they do they will have occasional issues with their breathing, especially if there's inflammation in the airway like that of colds and strep throat.

[JanetCCURN]

Thanks! thats really nice to know. Yup his history shows remarkable for tracheomalacia and laryngomalacia. He's got a ways to go before he completes 1yr. But his growth is actually exponential, of course due to his lil GT. Since D/C at 5mo 6.6lbs to almost a month later nearly 12lbs. We will see. I hope its not uncomfortable for him when he makes those noises, it just sounds like screetching or nails on a chalk board some times. I just wish there was something I can do.

[Shanny246]

My son also had a trach. He had his placed when he was 2.5 weeks old, and had it till he was 19 months old. He had a 3.0 neo as well, and never had it changed to a bigger size. I am wondering if the size does not work for this little guy. It may be too big for him. I would be curious to know how he would sound if you put the 3.0 back in.