What type of artificial airway should be recommended for a 10-year-old girl with a C-3 fracture requiring mechanical ventilation after 9 days of intubation?

In the scenario of a 10-year-old girl with a C-3 fracture who has been intubated for 9 days and requires mechanical ventilation, a tracheostomy tube is the most appropriate choice. Prolonged endotracheal intubation, especially beyond a week, can lead to complications such as damage to the trachea, difficulty in airway management, and increased risk of ventilator-associated pneumonia.

A tracheostomy provides a more stable and secure airway for long-term mechanical ventilation, allowing for better patient comfort, easier suctioning, and reduced work of breathing compared to prolonged endotracheal intubation. This intervention is also particularly beneficial in cases where there is a need for an extended duration of ventilatory support, as it reduces airway resistance and facilitates easier weaning from mechanical ventilation.

Other airway options, such as an uncuffed endotracheal tube, a laryngeal mask airway, or Carlen's tube, either do not provide the secure airway necessary for prolonged ventilation or are not primarily indicated for long-term management in this scenario. Therefore, the use of a tracheostomy tube aligns with best practices for patients requiring extended mechanical ventilation in a safe and comfortable manner.