Infection
1. Clinical presentation: acute ill symptoms (decreased activity, not tolerating feeds, increased WOB) changes in color, consistency or odor of secretions, oxygen requirement above baseline, often fever (2)
2. Testing
- Viral testing – Winter Viral Respiratory Panel
- Tracheal aspirate gram stain and culture
- CXR if indicated- i.e. hypoxia, focal exam findings (2)
3. Non-pharmacologic treatment
- Increase pulmonary clearance from BID to QID, increased frequency of suctioning
i. Review the patient’s last pulmonary note for the airway clearance plan.
- Support with increased O2 as needed
4. Pharmacologic treatment (2)
- Hypertonic Saline or Mucomyst – given to thin mucus and assist with clearance of mucus for routine pulmonary clearance or for when ill.
i. Hypertonic saline (Sodium Chloride 3% nebulized solution). 1 neb BID-QID
ii. Mucomyst (acetylcysteine 10% neb soln) 1 neb BID-QID
- Empiric inhaled gentamicin 40mg/mL- Topical antibiotic treatment for trach infection (2)
i. <5kg: 1 mL of gentamicin diluted with 2 mL of NS and give via neb BID-TID x 7-10 days
ii. > 5kg: 2 mL of gentamicin diluted with 2 mL of NS BID-TID x 7-10 days
- If ill-appearing and/or or severe symptoms -add empiric systemic antibiotic treatment based on previous tracheal culture
i. Consider Clindamycin for aspiration (gram positive coverage) (2)
ii. Consider Ciprofloxacin if history of pseudomonas (Gram negative coverage) (2)