Non-availability of medical consumables is a challenge in sub-Saharan Africa. Difficult weaning of a child
off tracheostomy is illustrated in this case.
Case report
A 3-month-old female with meningomyelocoele and hydrocephalus presented in Children Emergency
with features of aspiration pneumonitis. She had urgent endotracheal intubation, bronchial toileting, and
antibiotics at the intensive care unit.
Features of upper airway obstruction persisted after unsuccessful efforts at tracheal extubation. She had a
temporary tracheostomy with a size 4.0 ID non-cuffed polyvinyl chloride (PVC) tracheostomy tube on the
12th day. Subsequently, she had ventriculo-peritoneal (V-P) shunt and repair of meningomyelocoele, on the
14th day.
On the 30th day, decannulation became challenging due to non-availability of k8smaller sizes of
tracheostomy tubes to facilitate weaning. A size 3.0 ID PVC endotracheal was improvised (preformed) into
a tracheostomy tube. Decannulation was successful after 72 hours-
Conclusion
In this situation, available human resource is compelled to make the best of available types of equipment.