Neo to pedi trach

Colin's mom · #1 09-14-2003, 11:24 PM

At Colin's Bronch last week, the nurse put a Pedi trach by his bedside even though I told her he wears a Neo. The ENT happened to be in the room and said that was ok and it was time for him to change to the Pedi. Colin is just barely over 17 lbs. The Pedi trach just looks so big. Do they determine when a child is ready to switch based on the size of the child or the age? Would it make that big of a deal if he kept the Neo for a little longer?

indiemum · #2 09-14-2003, 11:43 PM

Hi Lesley,

We switched at 12mo to a 4.0 ped. Our doc (21yrs trach experience) told us that The longer bigger trach is much better because it is safer..........less likely to pop out and less likely to plug. I thought it looked huge too but Indie has done well with it and I have noticed that her sat's have been better and she has tolerated colds MUCH, MUCH BETTER. I feel good knowing that Indie is safer, it has erased some of my anxiety. Let us know what you decide, I hope your decision is an easy one that feels good for your family. Good Luck

Kelly

Jacks Mum · #3 09-15-2003, 03:28 AM

Hi lesley,
Each child is very different when moving up a trach size,
Jack was trached at 9 months (7 Corrected) he was given a 3.0 NEO shiley and moved up a few sizes within a few weeks to finally a 4.5 PED Shiley.. this was the size he needed in Diameter, but the tube was 4mm too long as he has a shorter tracheal then some..
The doctors usually perform an X-ray to see if its the correct size & length for Jack.
Good luck

cariaad · #4 09-15-2003, 05:01 AM

Alli was trached at 4 mos with a 3.0 neo and still uses that size. Our ORL says she has a tiny airway even for her small size tho (24 lbs 3 yrs) so maybe that has something to do with it..Deb

Jacob's Mom · #5 09-15-2003, 06:29 AM

Jacob graduated from a 3.5neo to a 3.5ped when he was 11 months old. (Just a few months later he went to a 4.0ped.) After a routine x-ray his pulmonologist said he needed a bigger trach and that is what he ordered. After the change I could tell a difference in secretion management and O2 saturation; they both changed for the better. Also, when a child is on a vent, I believe that the max size trach should be used (someone please confirm or correct this) to ensure the full ventilatory support is being given. Unfortunately, we have had more accidental decannulations with the larger trach than before. I think this just has to do with Jacob's activity level.

Good luck and let us know how it works out!

akabot · #6 09-15-2003, 07:47 AM

Corey went from a 4.5 Neo to a 5.0 Peds when he was 7 months old (14 pounds). It seemed awful big to me, but at the time Corey was on the ventilator and all of the pressure was leaking out of his mouth. It really took a bigger size to help him get the support from the ventilator that he needed.

Now Corey is off of the vent and he is back in a 4.5 Peds. He can vocalize with this size with the Passy-Muir on, but not without it.

Amy

trevors_mom · #7 09-15-2003, 08:16 AM

Hi, Trevor was trached right after birth, they put a 3.0 neo in and then he moved to a 3.5 about 6 to 8 months after that. He is now at a 4.0 and has been at that size for along time. His ent says that he dont need any bigger right now, Trevor will be 3 in Nov. I think it has to do with the trachea size and how dependent they are one the trach. If the trach needs to be about the size of the trachea, or if they can handle to breath therough their mouth and nose also it will stay at the smaller sizes. Does that make sense? His ent stated that the smaller it stays the easier it will be to close which makes sense. Take Care,

Hope

Stefan & Jennifer · #8 09-15-2003, 02:05 PM

We were told that the smallest trach tube that allows Jake to breathe should be used to "wean" him off the trach tube if decannulation fails. I guess because his breathing problems are based on a bone deformity, once that's fixed it's a matter of maturity--learn to swallow well, learn to eat and as he gets bigger the trach becomes a smaller and smaller component of his airway until it's basically just a psychological prop...hopefully he'll just handle decannulation before we have to wait a few years for him to "outgrow it," assuming that even happens.

Colin's mom · #9 09-15-2003, 11:53 PM

Thanks everyone for the responses. Very helpful. Sounds like it is better to keep the trach size down if possible. He wears a 3.5 Neo now and is able to make sound around it. l don't want him to lose that. I'm guessing he would go to a 3.5 Pedi? The only difference is length of the cannula, is that right?

Olga · #10 09-17-2003, 12:20 PM

Grace has had a 3.5 neo trachy since she was 6 months old.(She was first trached with a 3.0 neo). I don't think it will ever go up because she manages very well.
The size issue is not just about the size of the child, but also about why the trachy is there in the first place. Grace only has obstruction on her vocal cord so she does not need a longer cannula. Some children have narrowing of the airway further down and need a longer cannula to keep the airway open. I hope you find this useful. Olga