Tracheal aspirate cultures recommended to guide antibiotic therapy, but not for routine surveillance
By Elana Gotkine HealthDay Reporter
FRIDAY, Oct. 31, 2025 (HealthDay News) — Recommendations have been developed for management of pediatric patients with tracheostomies and published in a clinical practice guideline from the American Thoracic Society published online Oct. 22 in the American Journal of Respiratory and Critical Care Medicine.
Reshma Amin, M.D., from the Hospital for Sick Children in Toronto, and colleagues outlined management recommendations for children with tracheostomies, incorporating best evidence on diagnostic tools and care protocols. A multidisciplinary panel with expertise in pediatric tracheostomy care contributed to recommendations.
The panel presented a strong recommendation for applying ethical principles to guide shared decision-making regarding tracheostomy placement. Implementation of a standardized discharge process is suggested, involving comprehensive family caregiver training for safe transitions from the hospital to home (conditional recommendation). For children at risk for immediate decompensation due to tracheostomy-related complications, an awake, trained caregiver should always be present (strong recommendation). Tracheal aspirate cultures are recommended during acute respiratory episodes to guide antibiotic therapy, but are not recommended for routine surveillance (conditional recommendation). A complete airway evaluation is suggested for children with tracheostomies with a change in symptoms or with persistent symptoms unresponsive to medical management (conditional recommendation). In addition, complete airway evaluation is recommended prior to a decannulation event for children with tracheostomies (strong recommendation); as part of the evaluation, a polysomnography or pulse oximetry study under direct observation with a capped tracheostomy is suggested (conditional recommendation).
“We wrote these guidelines to help clinicians and family caregivers provide the best care possible, but ultimately it is up to each provider-caregiver partnership to decide what is best,” coauthor Christopher D. Baker, M.D., from Children’s Hospital Colorado, said in a statement.
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