Clinical outcomes and associated factors in pediatric patients undergoing tracheostomy in a public intensive care...

To describe clinical outcomes and identify predictors of death and complications in children undergoing tracheostomy at a public referral hospital in the Federal District.

A retrospective cohort study including 123 children (zero to 14 years) who underwent tracheostomy between 2017 and 2021. Patients under exclusive palliative care, those lost to follow-up, or with a tracheostomy performed prior to 2017 were excluded. Follow-up spanned from the procedure date until decannulation, death, or the study end (August 2, 2025), with a mean duration of 26.9 months. Data on demographics, clinical indicators, complications, and outcomes were analyzed using descriptive statistics, survival analysis (Kaplan-Meier), binary logistic regression, and Poisson regression.

The majority were infants (58.5%) and male (53.7%). Upper airway obstruction was the predominant indication (41.5%). The overall mortality was 39%, and septic shock was the leading cause (16.7%). Complications occurred in 52% of cases, most notably tracheitis (42.2%) and accidental decannulation (32.8%). Multivariate analysis identified the following as independent predictors of death: tracheitis (OR 4.79; 95%CI 2.15 - 10.68; p = 0.001), mechanical ventilation dependence (OR 3.43; 95%CI 1.52 - 7.74; p = 0.003), and accidental decannulation (OR 2.44; 95%CI 1.05 - 5.66; p = 0.037). Poisson regression showed that longer tracheostomy use time (IRR 1.137; p = 0.008) and complex chronic diseases (IRR 1.573; p = 0.011) were associated with higher complication rates.

Tracheostomized children in this public hospital setting experience high morbidity and mortality, influenced significantly by modifiable factors such as infection, ventilator dependence, and decannulation events.