From Intubation to Tracheostomy: Indications, Techniques, Complications, and Outcomes of Tracheostomy in an Indonesian Pediatric Intensive Care Unit, 2022–2026

Introduction: Tracheostomy is increasingly performed in critically ill children requiring prolonged mechanical ventilation; however, data from settings with a high infectious disease burden and on pediatric bedside percutaneous tracheostomy remain limited. This study described the characteristics, indications, techniques, complications, and outcomes of children undergoing tracheostomy in a pediatric intensive care unit (PICU) in Indonesia. Methods: This retrospective descriptive study included all PICU patients aged 1 month to 17 years who underwent elective tracheostomy at Bhayangkara Tk. I Pusdokkes Polri Hospital, Jakarta, between January 2022 and March 2026. Results: Forty-three children were included (mean age 7.8 ± 6.1 years; 58.1% boys); 28 (65.1%) were older than 5 years. The indications were prolonged mechanical ventilation (39; 90.7%) and upper airway obstruction (4; 9.3%). Neurological disease was the underlying cause in 30 cases (69.8%), with tuberculous meningitis being the most frequent diagnosis (9; 20.9%). Bedside percutaneous tracheostomy by intensivists was performed in 38 children (88.4%) and surgical tracheostomy in five (11.6%). The mean ventilation before tracheostomy was 10.2 days (range 1–16), and the mean post-tracheostomy PICU stay was 9.3 days (range 1–30). Complications occurred in seven children (16.3%): minor bleeding, pneumothorax, and laryngeal edema (two each) and subcutaneous emphysema (one), none requiring re-exploration. Twenty children (46.5%) were discharged with tracheostomy. In-hospital mortality was 53.5%, with no procedure-related deaths. Conclusion: Intensivist bedside percutaneous tracheostomy is feasible with few complications in children with acquired neurological diseases, particularly central nervous system infections. Mortality reflects disease severity rather than the procedure.