Abstract

Objective: Tracheostomy is frequently required in pediatric intensive care units (PICUs), particularly for children with complex neurological or respiratory conditions. This study aimed to evaluate the indications, outcomes, and the role of pediatric palliative care (PPC) services in the post-tracheostomy management of pediatric patients.

Materials and Methods: This retrospective, single-center study included 42 pediatric patients (0–18 years) who underwent their first tracheostomy in the PICU between January 2020 and November 2024. Demographics, clinical indications, complication rates, palliative care utilization, and discharge outcomes were analyzed descriptively.

Results: The median age was 2 (0–11.25) years, with 66.7% male patients. Prolonged intubation was the most common indication (66.7%), followed by subglottic stenosis and neuromuscular causes. Tracheostomy-related complications occurred in 40.4% of patients. Remarkably, 95.2% were transferred to the PPC unit, where they stayed for a median of 21 days. Discharge to home was achieved in 88.1% of patients, and overall mortality was 11.9%, with no deaths directly attributable to tracheostomy. Among discharged patients, 60.5% required home mechanical ventilation.

Conclusion: This study highlights the critical role of PPC services in facilitating safe discharge and optimizing outcomes for children undergoing tracheostomy. The high home discharge rate and low mortality underscore the benefits of a structured, multidisciplinary care model. Integration

References

  1. Singh A, Zubair A. Pediatric Tracheostomy. In: StatPearls. StatPearls Publishing; 2026. http://www.ncbi.nlm.nih.gov/books/NBK560622/
  2. Komori M. Update on pediatric tracheostomy. Auris Nasus Larynx. 2024;51(3):429-32. https://doi.org/10.1016/j.anl.2024.01.003
  3. Can FK, Anıl AB, Anıl M, Gümüşsoy M, Çitlenbik H, Kandoğan T, et al. The outcomes of children with tracheostomy in a tertiary care pediatric intensive care unit in Turkey. Turk Pediatri Ars. 2018;53(3):177-84. https://doi.org/10.5152/TurkPediatriArs.2018.6586
  4. Atay G. Tracheostomy in Pediatric Intensive Care: A Single Center Experience. Forbes J Med. 2021;2(3):150-3. https://doi.org/10.4274/forbes.galenos.2021.29491
  5. Jain MK, Patnaik S, Sahoo B, Mishra R, Behera JR. Tracheostomy in Pediatric Intensive Care Unit: Experience from Eastern India. Indian J Pediatr. 2021;88(5):445-9. https://doi.org/10.1007/s12098-020-03514-6
  6. Pérez-Ruiz E, Caro P, Pérez-Frías J, et al. Paediatric patients with a tracheostomy: a multicentre epidemiological study. Eur Respir J. 2012;40(6):1502-7. https://doi.org/10.1183/09031936.00164611
  7. Berry JG, Graham DA, Graham RJ, et al. Predictors of Clinical Outcomes and Hospital Resource Use of Children After Tracheotomy. Pediatrics. 2009;124(2):563-72. https://doi.org/10.1542/peds.2008-3491
  8. Adissem ZW, Gewirtz JI, Kistler I, et al. Effects of dedicated inpatient rounds on tracheostomy care in children. Int J Pediatr Otorhinolaryngol. 2025;194:112375. https://doi.org/10.1016/j.ijporl.2025.112375
  9. Weaver MS, Shostrom VK, Kaye EC, Keegan A, Lindley LC. Palliative Care Programs in Children’s Hospitals. Pediatrics. 2022;150(4):e2022057872. https://doi.org/10.1542/peds.2022-057872
  10. Garrubba M, Turner T, Grieveson C. Multidisciplinary care for tracheostomy patients: a systematic review. Crit Care. 2009;13(6):R177. https://doi.org/10.1186/cc8159
  11. Sarica S, Bi̇lal N, Altinisik M, et al. Analysis of Pediatric Intensive Care Unit Patients Who Underwent Tracheotomy. Turkish J Pediatr Dis. Turkish J Pediatr Dis. 2017;11:171–4. https://doi.org/10.12956/tjpd.2016.259
  12. Wakeham MK, Kuhn EM, Lee KJ, McCrory MC, Scanlon MC. Use of tracheostomy in the PICU among patients requiring prolonged mechanical ventilation. Intensive Care Med. 2014;40(6):863-70. https://doi.org/10.1007/s00134-014-3298-4
  13. Butnaru CS, Colreavy MP, Ayari S, Froehlich P. Tracheotomy in children: Evolution in indications. nt J Pediatr Otorhinolaryngol 2006;70(1):115-9. https://doi.org/10.1016/j.ijporl.2005.05.028
  14. Dursun A, Tekerek NÜ, Akyıldız B. The evaluation of tracheotomy cases in the pediatric ıntensive care unit: the results of decanulation and weaning from mechanical ventilator. Turk J Pediatr Dis. 2018;12(2):74-8. https://doi.org/10.12956/tjpd.2017.289
  15. Tolunay İ, Yıldızdaş RD, Horoz ÖÖ, et al. An assesment of pediatric tracheostomy in a pediatric intensive care unit. Turk J Ped Em Int Care Med. 2015;2(2):61-4. https://doi.org/10.5505/cayb.2015.09797
  16. Hatice Feray Arı, Nezihe Bilge Bahçeci, Hüseyin Başpınar, Murat Turhan, Murat Arı, Adem Keskin. Tracheostomy Etiologies and Clinical Evaluation of Pediatric Intensive Care Patients: A Retrospective Study. Akd Med J. 2024;10(2):248-55. https://doi.org/10.53394/akd.1216185
  17. El-Anwar M, Nofal A, Shawadfy M, Maaty A, Khazbak A. Tracheostomy in the Intensive Care Unit: a University Hospital in a Developing Country Study. Int Arch Otorhinolaryngol. 2016;21(01):33-7. https://doi.org/10.1055/s-0036-1584227
  18. Kluge S, Baumann HJ, Maier C, et al. Tracheostomy in the Intensive Care Unit: A Nationwide Survey. Anesth Analg. 2008;107(5):1639-43. https://doi.org/10.1213/ane.0b013e318188b818
  19. Zia S, Arshad M, Nazir Z, Awan S. Pediatric tracheostomy: complications and role of home care in a developing country. Pediatr Surg Int. 2010;26(3):269-73. https://doi.org/10.1007/s00383-009-2494-8
  20. De Trey L, Niedermann E, Ghelfi D, Gerber A, Gysin C. Pediatric tracheotomy: A 30-year experience. J Pediatr Surg. 2013;48(7):1470-5. https://doi.org/10.1016/j.jpedsurg.2012.09.066
  21. Holloway AJ, Spaeder MC, Basu S. Association of Timing of Tracheostomy on Clinical Outcomes in PICU Patients: Pediatr Crit Care Med. 2015;16(3):e52-e58. https://doi.org/10.1097/PCC.0000000000000336
  22. Brook AD, Sherman G, Malen J, Kollef MH. Early versus late tracheostomy in patients who require prolonged mechanical ventilation. Am J Crit Care. 2000;9(5):352-9. https://doi.org/10.4037/ajcc2000.9.5.352
  23. Lee JH., Koo CH., Lee SY., et al. Effect of early vs. late tracheostomy on clinical outcomes in critically ill pediatric patients. Acta Anaesthesiol Scand. 2016;60(9):1281-8. https://doi.org/10.1111/aas.12760
  24. İsik S, Alyamac Di̇zdar E, Erteki̇n O, et al. Tracheostomy in Neonatal Intensive Care Unit. JGON. 2020;17(2):339-41. https://doi.org/10.38136/jgon.639823
  25. Schwantes S, Wells O’Brien H. Pediatric Palliative Care for Children with Complex Chronic Medical Conditions. Pediatr Clin North Am. 2014;61(4):797-821. https://doi.org/10.1016/j.pcl.2014.04.011
  26. Feudtner C, Womer J, Augustin R, et al. Pediatric Palliative Care Programs in Children’s Hospitals: A Cross-Sectional National Survey. Pediatrics. 2013;132(6):1063-70. https://doi.org/10.1542/peds.2013-1286
  27. Mahadevan M, Barber C, Salkeld L, Douglas G, Mills N. Pediatric tracheotomy: 17 year review. Int J Pediatr Otorhinolaryngol. 2007;71(12):1829-35. https://doi.org/10.1016/j.ijporl.2007.08.007
  28. Carr MM, Poje CP, Kingston L, Kielma D, Heard C. Complications in Pediatric Tracheostomies. Laryngoscope. 2001;111(11):1925-8. https://doi.org/10.1097/00005537-200111000-00010

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Copyright © 2026 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Duyar MO, Dündar MA, Durna T, SARIÇİÇEK A. Tracheostomy in pediatric intensive care: A comprehensive overview of indications, clinical outcomes, and the role of palliative care. Turk J Pediatr Dis. 2026;Early View:1-6. https://doi.org/10.12956/TJPD.2026.1313