In healthy people, respiration is maintained via a complex mechanism involving the alveolocapillary network, the diaphragm and intercostal musculature, and the central respiratory centers in the brainstem Respiratory compromise results when one or more components of this mechanism are affected by disease Chronic respiratory support may be a part of the management plan for children with diverse disease processes, including neurologic and neuromuscular disorders, central hypoventilation syndromes, obstructive apnea, congenital facial and airway anomalies, and others Processes such as bronchopulmonary dysplasia once accounted for the majority of CRI; however, recent epidemiologic studies have demonstrated a shift in the proportion of CRI from chronic lung disease to neurologic and neuromuscular disorders Equipment The complexity of the many tubes and attachments extending from the patient’s airway can be overwhelming, especially in the emergent situation Familiarity with the equipment used in caring for a patient with a tracheostomy ensures the emergency physician’s adept management of these situations Starting from the patient’s neck, each piece of equipment can be easily identified ( Fig 135.1 ) FIGURE 135.1 Tracheostomy parts