Outcomes of pediatric tracheostomy with a standardized surgical technique: A retrospective single-center analysis

Abstract

Objective

Pediatric tracheostomy is a life-saving procedure for children requiring prolonged mechanical ventilation or airway protection. This study evaluated clinical outcomes, postoperative respiratory changes, and complications in pediatric tracheostomy cases performed using a structured institutional surgical and postoperative management framework.

Methods

This retrospective single-center cohort included 43 pediatric patients (0–18 years) who underwent tracheostomy at a tertiary care hospital in İzmir, Türkiye, between October 2023 and September 2025. Demographics, tracheostomy indications, complications, ventilatory parameters, decannulation outcomes, and mortality were analyzed. Positive end-expiratory pressure (PEEP), peak inspiratory pressure (PIP), and fraction of inspired oxygen (FiO₂) were recorded preoperatively and at postoperative 24 h, 72 h, and day 7 while patients remained on invasive mechanical ventilation. Longitudinal changes were analyzed using linear mixed-effects models.

Results

Median age was 12 months (IQR 4–90), and 51.2% of patients were male. The most common indications were neuromuscular disease (51.2%) and chronic respiratory failure (37.2%) and upper airway obstruction or malformation (11.6%). No major intraoperative complications occurred. Early and late postoperative complications were observed in 14.0% and 30.2% of patients, respectively, most commonly cannula-related events. Mixed-effects modeling demonstrated significant longitudinal improvement in ventilatory parameters. Mean PEEP decreased from 6.30 to 5.07 cmH₂O, PIP from 17.51 to 14.12 cmH₂O, and FiO₂ from 34.30% to 26.65% by postoperative day 7 (all p < 0.001). Overall, 3 patients (7.0%) were successfully decannulated. Among the remaining tracheostomy-dependent patients, 15/29 (51.7%) achieved spontaneous breathing without invasive mechanical ventilation.

Conclusion

Pediatric tracheostomy performed within a structured multidisciplinary framework was intraoperatively safe and associated with significant early improvement in ventilatory parameters. These findings support the feasibility of protocol-based perioperative management and may help inform future prospective comparative studies.