Lifewatch: New way to help children breathe

Reported by Claire Hosmann - bio|email
Posted by Debra Worley - email

(WECT) - Inserting a tube into a baby's airway is the most common way to help them breathe if they are having trouble.

Now doctors are looking for other options that could help the tiniest patients breathe more easily.

The standard procedure is a tracheotomy - where doctors make an incision in the neck and insert a plastic tube to help the child breathe.  This procedure makes it more difficult to take care of the patient, and in one percent of cases the tube can get blocked, suffocating the child.

"It requires meticulous care, nursing care, suctioning, monitoring," said Dr. Diego Preciado.

Preciado recommended another option - take a piece of cartilage from the child's rib cage, mold it into shape, and then transplant it into the child's throat to form a wider airway.

"So the rib graft is essentially spreading, expanding, distracting the airway apart, making a new roof and a new floor," said Preciado.

The goal is to help the airway grow as the baby grows.

"The primary risk of this procedure is that it won't work and the child needs a tracheotomy afterwards," said Preciado.

The best candidates for this procedure are children between the ages of one and four.  It can be performed on adults to replace a tracheotomy, but children have a better outcome.

For more information, please contact
Children's National Medical Center
Washington, D.C.

BACKGROUND: A tracheotomy is a surgical procedure in which a cut or opening is made in the windpipe. The surgeon inserts a tube into the opening to bypass an obstruction, allowing air to get to the lungs, or remove secretions. It's performed if a person is not getting enough air to his lungs, if the person cannot breathe without help, or is having problems with mucus and other secretions getting into the windpipe. After the patient goes home, he will need help to manage the tracheotomy tube. He should avoid contact with water, food particles and other substances that could enter the opening and cause serious breathing problems.

LIVING WITH A TRACH: Patients with a trach are really dependent on the tube to live and it can be difficult to care for.  The internal diameter of the tube is about three millimeters and any mucus that blocks the tube also blocks the airway. "It requires very meticulous care, nursing care, suctioning and monitoring," Diego Preciado, M.D., Ph.D., of Children's National Medical Center in Washington, D.C., told Ivanhoe. "Approximately 1 percent of the time kids can die because of a blocked trach tube. You can imagine having a young baby with all the cares that are required with a young baby just to begin with. On top of that you add a trach tube, it's often too complex for families to take care of on their own."

ALTERNATIVE TO TRACHEOTOMY: In some cases, especially in children, surgeons are looking for alternatives to tracheotomies. One of the alternatives is a laryngeal tracheal reconstruction procedure. A segment of cartilage is taken from the rib cage and molded to reconstruct the front part of the airway. It's used when the airway or the upper trachea is scarred. This can happen because somebody is born with a narrowed airway or typically from scarring, which often occurs due to an intubation. "Typically we're dealing with the airway either just at the level of the vocal chords or just below the vocal chords in children, because this is the narrowest portion of the airway," said Dr. Preciado. "Approximately one in 300 one in 500 intubations in preemies or young children can lead to narrowing."

RISKS: The main risk of this procedure is that it won't work and a child needs a tracheotomy afterwards. "That's the primary risk is that you make the pathology worse in trying to fix it early on, such that when you fix it later it's harder," said Dr. Preciado. There are also risks that go along with typical surgical procedures such as infection, bleeding and airway obstruction.

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