Pediatric tracheotomy: A 25-year experience at a portuguese tertiary children's hospital

Tracheotomy is a procedure that aims to ensure airway patency in patients with respiratory failure, when there is a high risk of upper airway obstruction or a need for prolonged mechanical ventilation. It has, as expected, profound implications for patients' quality of life and family dynamics. The aim of this study is to present the case series of pediatric tracheotomies over the last 25 years in a tertiary pediatric hospital. A retrospective observational study was conducted on pediatric patients who underwent tracheotomy at the Otolaryngology Department of Coimbra's Local Health Unit, between April 2000 and April 2025. A total of 44 patients were included, with a median age of 4 months and the majority (59%) being male. A median of 2 tracheotomy procedures were performed per year, with a maximum of 6 procedures performed in 2014. The most common indication for tracheotomy was airway obstruction (32%), followed by laryngeal immobility due to neurological impairment (29%), craniofacial anomalies (23%), cardiopulmonary disease (14%), and, lastly, traumatic injury (2%). Complications were recorded in 32% of patients, the majority being tracheal obstructions (5 cases) and accidental decannulations (5 cases). There was no tracheotomy related mortality. Overall mortality rate was 41% and it was higher in cases of neurological dysfunction, mostly due to progression of the underlying disease. Our results show that pediatric tracheotomy is a safe and effective procedure. Outcomes highlight the need for close monitoring and individualized perioperative care, especially in children with severe comorbidities.