Bedside Tracheostomy for Pediatric Critically Ill patients in PICU: Clinical Experience in a Single center

Background Children with neurological impairments, especially those who are bedridden, 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 39 bedridden 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 stay and hospitalization stay compared to the group that received it later. Conclusions Tracheostomy is a procedure necessary for resolving respiratory difficulties in children with neurological impairments who are typically bedridden. As complications and mortality rates can be high in this population, careful and appropriate care is necessary.