Bedside Tracheostomy for Critically Ill Pediatric Patients in the PICU: Clinical Experience in a Single Center

Background/Objectives: Children with neurological impairments, especially those who are non-ambulatory, may require additional care services beyond what is available for the general pediatric population, and tracheostomy may be necessary for addressing respiratory problems, but no established consensus or clear guidelines have been established on the optimal timing of this procedure in the pediatric intensive care unit (PICU). Methods: We conducted a study involving 38 patients with neurological impairments who underwent tracheostomy in the PICU from January 2017 to December 2022. We collected demographic, tracheostomy, and outcome data and compared the data between two groups based on the duration of mechanical ventilation before tracheostomy. Results: The patients had heterogeneous neurological conditions, with refractory epilepsy being the most common. Almost all patients received tracheostomy for prolonged mechanical ventilation, with a median duration of 14.5 days of mechanical ventilation before the procedure. A majority of the patients (60.5%) experienced complications related to tracheostomy. The overall mortality rate was 36.8%, with 7.9% directly related to tracheostomy. When the patients were divided into two groups based on the median duration of mechanical ventilation before tracheostomy, the group that received tracheostomy earlier had significantly shorter total PICU stays and hospitalization stays compared to the group that received it later. Conclusions: Children with neurological impairments who undergo tracheostomy have substantial comorbidities and a high rate of complications and mortality. Earlier tracheostomy, based on shorter mechanical ventilation duration, was associated with significantly reduced PICU and hospital stay without increasing adverse outcomes. These findings suggest that timely tracheostomy may improve resource utilization in this medically fragile population.