Episode 05

Pediatric Tracheostomy: The Long Game

with Dr. Romaine Johnson

Dr. Romaine Johnson talks us through the challenges of pediatric tracheostomy care and the importance of building high reliability tracheostomy teams.

A BackTable Production

BackTable, LLC (Producer). (2020, September 4). Ep. 05 – Pediatric Tracheostomy: The Long Game [Audio podcast]. Retrieved from https://www.backtable.com/podcasts

In this Episode

Podcast Participants

Dr. Romaine Johnson is a practicing ENT and Associate Professor at UT Southwestern Medical Center in Dallas, TX.

Host Dr. Gopi Shah is a practicing ENT at UT Southwestern Medical Center in Dallas, TX.

Co-host Dr. Ashley Agan is a practicing ENT and assistant professor at UT Southwestern Medical Center in Dallas, TX.

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Show Notes

In this episode, Dr. Romaine Johnson joins Dr. Gopi Shah and Dr. Ashley Agan to discuss the essentials of building a successful pediatric tracheostomy program and the importance of a multidisciplinary team. He emphasizes that the triage and management of pediatric tracheostomy patients must be approached through the lens of long-term care.

He states that essential members of the multidisciplinary pediatric tracheostomy team include pediatric pulmonologists, advanced practice nurses/nurse practitioners, respiratory and speech therapists, as well as social workers and case managers. Dr. Johnson also describes his multidisciplinary clinic set up through which patients are able to see all members of their care team at a single visit, thereby improving the quality and safety of care.

Dr. Johnson provides some key insights into the management of inherited pediatric tracheostomies with regards to how and when to up-size a trach as well as the role of palliative care in complex pediatric tracheostomy cases. Finally, we go into some notes on how to manage bleeding complications in pediatric tracheostomy patients, including the role of a pulmonary sick plan, and management of anterior/posterior tracheal erosions.


Dr. Johnson’s YouTube Channel
Dr. Johnson regularly posts procedure videos, as well as videos from the Harry Barnes society virtual grand round series.

Transcript Preview

[Romaine Johnson MD]
Wow. Everyone should at least know them. Well, I think so I'll take it a different way. So I think that you should always bet on yourself, that you can be better. And that you can solve complex problems, particularly if they're kind of human relation problems. Often what happens is you find yourself in a work environment, where there's conflict, and there's people working against each other and butting heads. And that's the reason why you have systemic error in something like tracheostomy patients. You'll find that there's just people who, that's the way they do trachs or no one takes the care of people with tracheostomy seriously or you don't think anybody wants to make things better.

And I would say that that's not true. I think, wherever you are, if you really set out to make positive change, positive change will happen. There's this book called the, what is it? The Alchemist. And in part of it, he says, "The whole universe works with you, if you're pursuing kind of your personal legend." I think if you're pursuing something positive, and you're trying to make a real significant impact on your work environment, on whatever it is, I do think the universe aligns and works with you. And so that would be my final piece of advice to everyone.

Disclaimer: The Materials available on the BackTable Podcast are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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