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Tracheotomy may be necessary in the treatment of severe, prolonged illness or airway obstruction. The preoperative nursing care plan is developed to meet the physical needs of the child as well as provide essential information and emotional support to the child and family. Comprehensive attention to all aspects of care needs in the preoperative period assists in the provision of optimum nursing care during the hospital stay and after discharge.

118 patients suffering from severe chronic respiratory failure were submitted to domiciliary artificial ventilation (V.A.D.T.) by tracheotomy using a fixed rate volumetric respiration. The daily length of V.A.D.T. was 10 to 16 hours. The improvement on the blood gases, their stability, the disappearance of signs of right heart failure and polycythaemia, as well as a large reduction in mean length of hospital stay per subject and per year after V.A.D.T., underlined the efficacy of this method. In the long term (10 years) there was a 50% survival in patients with restrictive respiratory failure and of 33% in subjects with a mixed respiratory failure, which was predominantly restrictive. It was lower with mixed respiratory failure that was predominantly obstructive (20%). No patient with isolated airflow obstruction survived more than six years.