IMPLEMENTATION OF AN OUTPATIENT RESPIRATORY PHYSIOTHERAPY SERVICE FOR PEDIATRIC PATIENTS WITH TRACHEOSTOMY

Abstract

Introduction: Pediatric tracheostomy is an essential procedure for maintaining the airway of children with complex clinical conditions, such as malformations, neuromuscular diseases, prematurity, and prolonged dependence on ventilation. Although it guarantees survival, it is associated with frequent complications such as mucous plugs, obstructions, infections, and emergency cannula changes, often related to a lack of guidance and follow-up after discharge. In Marabá (PA), the lack of structured services for continued care contributes to avoidable readmissions and insecurity among caregivers. In this context, a respiratory physiotherapy service for tracheostomized children was implemented at the Pediatric Outpatient Clinic for Special Devices (AMPEDE), aiming to strengthen outpatient care, prevent complications, and increase family autonomy. Methods: This is a descriptive experience report on the implementation of an outpatient respiratory physiotherapy service for children with tracheostomies, developed at AMPEDE, located at the Instituto Sonho e Esperança de Restituir Vidas (SERVI), in Marabá-PA. The implementation occurred in four stages: (1) integrative literature review; (2) physical and logistical organization; (3) development of 12 Standard Operating Procedures (SOPs); and (4) practical validation with follow-up of the first patients. Appointments were held twice a week, in the morning, following standardized care flows. Children aged 0 to 12 years, clinically stable and accompanied by caregivers, were included. Data were obtained from physiotherapy assessment forms and progress notes, using the Informed Consent Form. The project was approved by the Research Ethics Committee of UEPA. Experience Report: The implementation arose from the need observed by AMPEDE professionals due to the lack of continuous follow-up for tracheostomized children. Partnerships with SERVI provided physical space, supplies, and administrative support. Standard Operating Procedures (SOPs) were developed for reception, assessment, respiratory techniques, aspiration, caregiver training, and discharge, in addition to a specific form for respiratory assessment. Between October and November 2025, four patients were monitored, all female, aged between 1 year and 1 month and 11 years, with neurological conditions, prematurity, or laryngomalacia. Interventions included bronchial hygiene techniques, lung re-expansion, secretion aspiration, clinical monitoring, and health education. Families reported insecurity in home management, transportation difficulties, and a lack of prior specialized follow-up. Discussion: Initial results demonstrated a reduction in tracheostomy secretion, prevention of mucous plugs, and a lower frequency of complications, consistent with evidence highlighting the role of respiratory physiotherapy in maintaining airway patency and preventing adverse events. The training of caregivers proved essential, increasing safety and autonomy for home care management. Among the challenges, limited access to specialized public transportation stands out, compromising adherence and highlighting the impact of social determinants of health and the need for public policies to support families. The service is configured as a device for social inclusion and qualification of the care network. Final considerations: The implementation of the respiratory physiotherapy service at AMPEDE represented an advance in the care of tracheostomized children in Marabá, impacting the prevention of respiratory complications, the qualification of home care management, and the safety of caregivers. The structured model, based on protocols and continuing education, proved viable and fundamental to promoting comprehensive and continuous care. Therefore, its expansion and consolidation as a permanent policy is recommended, as well as the replication of the experience in other municipalities, contributing to the improvement of clinical outcomes and the dignity of children with complex conditions.