Bigger trach

Momi2AntnJadyn · #1 02-26-2004, 06:16 PM

Well Jadyn had a doctor appt. today and they upsized her trach from a 3.5 to a 4.0 Peds Shiley. She has been really coughing and gagging all day since they did that... is that normal or unrelated to the upsizing? Do sats ever go up or does anything improve when the size of the trach is increased? Right after they put in the new trach, Jadyn was coughing and gagging and her pulmonologist said if it persists, to change her back to a 3.5... what do you guys think? She's sleeping now, and is fine, but when she wakes up I don't know if she'll go back to doing that or what.

indiemum · #2 02-26-2004, 08:01 PM

Hi Amanda,

Indie went to a 4.0 last August. We were told that coughing and gagging were very normal but if it continued for a long time we may need to downsize. Indie only coughed for a while and within a few days she was fine but I did notice that the secretions went on for a couple of months. Our doc told us that the bigger the trach, the safer the kid i.e. less chance of plugs etc. I have also noticed that she has required less O2 when sick than last winter. Our doc said that if the problem persited with gagging etc that we would try a 4.0 neo which is shorter than the ped but thank-goodness we did ok with the ped. Good Luck, hope your peanut settles soon.

Kellyxo

christyw · #3 02-26-2004, 09:34 PM

We've never really upsized, at least not in the last 2 years or so. I would imagine that it could cause some coughing and gagging, but maybe she will adapt to it over the next day or two. If it's really persistent, I'd just switch back...but if it's tolerable, then maybe wait it out a little. Why was he upsizing? To stop a leak on the vent??

Christy

Momi2AntnJadyn · #4 02-27-2004, 02:19 PM

You know, I don't really know exactly why they upsized. At her appointment yesterday, I just asked out of curiosity if they ever do upsize, and her doctor said, "Yeah, we can do it today, she's almost 10 kilos." So I just thought once they reached a certain weight or something, they thought about upsizing the trach, I don't know. She said since we won't be decannulating anytime soon, we might as well upsize the trach?

Stefan & Jennifer · #5 02-27-2004, 02:26 PM

Jake went from a 3.5 NEO Shiley to a 4.0 NEO Shiley in May of 2003. The ENT looked at his little finger and compared it to the size of the trach and said that a 4.0 was appropriate.
He said the kid's little finger is about the size of the trachea and is a good measuring device (Man, I hate those highly technical doctor explanations, don't you?)

Anyway, yes, Jake's secretions went up and he coughed and gagged a bit more for a few days but it was all well and good after a couple of months....then he got a 4.0 PEDI in October and it started all over again.

Now, he's coughing and gagging because he has nasal stents in. But....after he got the 4.0 he didn't need the 1/8 liter of oxygen at night any more to keep his sats up above 95.

Good luck, take care.

christyw · #6 02-27-2004, 03:45 PM

Amanda

I just asked about the upsizing, because I've heard that it's common for the docs to just let the child stay in a 3.5 or 4.0 and then grow around that. But when a ventilator is involved, a huge leak can compromise pressure in the lungs. So, I thought that might be what it was all about with Jadyn.

Christy

Olga · #7 02-28-2004, 08:04 AM

Grace's trachy was upsized from a 3.0 neo to a 3.5 neo when she was 6 months old, but luckily it didn't cause the coughing and gagging. It stopped her plugging any more and suctioning was a little easier because you can get more out in one go. Common sense tells me that going from a neo to a ped is bound to cause more gagging becasue the position at the end of the trachy is further down the airway. Since Grace had the obstruction on her vocal cords only then there was no need to go up to a ped, as her lower airway was fine. If the coughing goes on for much longer perhaps you should seek another opinion as the cannula on the ped may just be a little too long. Olga

hcs_mom · #8 02-29-2004, 06:48 AM

Do you think an upsized trach could also cause problems with feeding? Hannah had hers upsized a few weeks ago and ever since she has been even harder to feed. You have to have her positioned "just so" or she fights until she gets comfortable.

Jimmysmom · #9 03-01-2004, 08:50 AM

Jimmy has been upsized a lot. There were a few times when we upsized that he did a lot of coughing and gagging. Usually it would go away, but one time it meant that the trach was too long. He needed the diameter for his leak, so they had to have them customized for the length..

Take care

Anne, mom to Jimmy (4) Infantile Axonal Polyneuropathy, trach, vent dependent, g-tube, spinal fusion with growth rods