Spinal Muscular Atrophy (SMA) with Acute Respiratory Failure Clinical Pathway — PICU
Considerations for Tracheostomy in Patients with SMA
When to Consider a Tracheostomy
Indications are not absolute, but are general thoughts as to when to consider tracheostomy discussion. This discussion should only be undertaken in collaboration with patient’s primary pulmonologist and PACT team if they are involved.
Indication | Specific Considerations |
---|---|
Inability to provide adequate mechanical ventilation/airway clearance non-invasively |
|
Inability to extubate patient after acute illness after multiple attempts despite: |
|
Patient family amenable to tracheostomy |
|
Considerations for Tracheostomy
- Consider tight to shaft (TTS) cuffed tube to provide for adequate ventilation during sleep but leak to support phonation when awake
- Speaking valve should be introduced whenever possible