{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T05:52:15Z","timestamp":1785909135678,"version":"3.56.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Long-term decannulation outcomes after pediatric tracheostomy, particularly among children discharged from the pediatric intensive care unit (PICU), remain poorly described. This study aimed to describe the long-term decannulation outcomes and factors associated with delayed decannulation within 180 days after hospital discharge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed children aged 29 days to 18 years who underwent first-time tracheostomy in the PICU of Beijing Children's Hospital between January 2016 and December 2020. Follow-up data were obtained from medical records and standardized telephone interviews through August 31, 2025. The cumulative decannulation rate was estimated using the Kaplan\u2013Meier analysis. Factors associated with delayed decannulation were analyzed using Cox regression. The discriminative ability of the independently associated factors in combination was assessed using receiver operating characteristic (ROC) curve analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 234 children who underwent tracheostomy, 121 survivors with complete follow-up data were included in the final analysis. The median age at tracheostomy was 60 months (IQR, 15\u2013111 months), and 30 patients (24.8%) were aged \u22641 year. At least one post-tracheostomy complication occurred in 66 children (54.5%), with late complications occurring in 62 children (51.2%). During final follow-up, 106 patients (87.6%) achieved successful decannulation, with a median time to decannulation of 126 days (IQR, 68\u2013332). Within 180 days after discharge, 62 children (51.2%) achieved successful decannulation. Multivariable Cox regression analysis showed that age \u22641 year, obstructive airway disease, and poor cough reflex were independently associated with delayed decannulation within 180 days. The combination of these factors showed good discriminatory ability for 180-day decannulation status (AUC, 0.854; 95% CI, 0.783\u20130.926).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Prolonged tracheostomy dependence was common after PICU discharge, with approximately half of children remaining cannulated at 180 days. Infancy, obstructive airway disease, and poor cough reflex were independently associated with delayed decannulation. Ventilator dependence and late complications were also associated with delayed decannulation. These late complications included respiratory infections, tube-related events, swallowing or phonation disorders, granulation tissue formation, tracheocutaneous fistula, and tracheal stenosis or malacia. These findings highlight the importance of individualized airway assessment, effective secretion management, surveillance for late complications, and continued multidisciplinary follow-up after discharge.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1880157","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T05:39:08Z","timestamp":1785908348000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with delayed decannulation within 180 days after pediatric tracheostomy in the PICU: a retrospective cohort study"],"prefix":"10.3389","volume":"14","author":[{"given":"Wenmiao","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingya","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health","place":["Beijing, China"]},{"name":"Department of Pediatrics, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiansheng","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaonan","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suyun","family":"Qian","sequence":"additional","affiliation":[{"name":"Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1684","DOI":"10.1002\/ppul.25952","article-title":"Indication-based timing of tracheostomy and its effects on outcome in the pediatric intensive care unit","volume":"57","author":"Sachdev","year":"2022","journal-title":"Pediatr Pulmonol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1097\/CCM.0000000000004114","article-title":"Timing of tracheostomy in pediatric patients: a systematic review and meta-analysis","volume":"48","author":"Abdelaal Ahmed Mahmoud","year":"2020","journal-title":"Crit Care Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"894","DOI":"10.1159\/000548148","article-title":"Impact of tracheotomy and its timing on outcomes in pediatric patients with prolonged mechanical ventilation: a multicenter study in China","volume":"104","author":"Liu","year":"2025","journal-title":"Respiration"},{"key":"B4","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s13052-020-0778-8","article-title":"Characteristics and outcomes in children on long-term mechanical ventilation: the experience of a pediatric tertiary center in Rome","volume":"46","author":"Pavone","year":"2020","journal-title":"Ital J Pediatr"},{"key":"B5","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1136\/adc.2009.180836","article-title":"Patient characteristics associated with in-hospital mortality in children following tracheotomy","volume":"95","author":"Berry","year":"2010","journal-title":"Arch Dis Child"},{"key":"B6","doi-asserted-by":"publisher","first-page":"4674","DOI":"10.1002\/lary.31586","article-title":"Impact of obesity on timing of tracheotomy: a multi-institutional retrospective study","volume":"134","author":"Yousef","year":"2024","journal-title":"Laryngoscope"},{"key":"B7","doi-asserted-by":"publisher","first-page":"101480","DOI":"10.1016\/j.jped.2025.101480","article-title":"Clinical characteristics and gaps in palliative care among tracheostomized children: a retrospective observational study","volume":"102","author":"Luna","year":"2026","journal-title":"J Pediatr (Rio J)"},{"key":"B8","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1016\/j.jped.2021.07.004","article-title":"Tracheostomy practices in children on mechanical ventilation: a systematic review and meta-analysis","volume":"98","author":"De Araujo","year":"2022","journal-title":"J Pediatr (Rio J)"},{"key":"B9","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1007\/s00431-024-05830-x","article-title":"Factors associated with early mortality in pediatric tracheostomy placement: a retrospective cohort study","volume":"184","author":"Noy","year":"2024","journal-title":"Eur J Pediatr"},{"key":"B10","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1097\/MOP.0000000000001559","article-title":"Pediatric tracheostomy-associated respiratory infections: an evolving paradigm","volume":"38","author":"Morrison","year":"2026","journal-title":"Curr Opin Pediatr"},{"key":"B11","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1007\/s40136-021-00340-y","article-title":"Update on pediatric tracheostomy: indications, technique, education, and decannulation","volume":"9","author":"Fuller","year":"2021","journal-title":"Curr Otorhinolaryngol Rep"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.1136\/thorax-2022-219557","article-title":"Tracheostomy in children is associated with neutrophilic airway inflammation","volume":"78","author":"Powell","year":"2023","journal-title":"Thorax"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2761","DOI":"10.1002\/ppul.25170","article-title":"Comparing decannulation failures and successes in pediatric tracheostomy: an 18-year experience","volume":"56","author":"Kolb","year":"2021","journal-title":"Pediatr Pulmonol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"111934","DOI":"10.1016\/j.ijporl.2024.111934","article-title":"Time considerations and outcomes in pediatric tracheostomy decannulation","volume":"179","author":"Lloyd","year":"2024","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1097\/MOO.0000000000000929","article-title":"Pediatric tracheostomy decannulation: what\u2019s the evidence?","volume":"31","author":"Raynor","year":"2023","journal-title":"Curr Opin Otolaryngol Head Neck Surg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"112452","DOI":"10.1016\/j.ijporl.2025.112452","article-title":"Outcomes of infant laryngotracheal reconstruction in tracheostomy decannulation and avoidance","volume":"195","author":"Lloyd","year":"2025","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"101068","DOI":"10.1016\/j.jscai.2023.101068","article-title":"Bronchial remodeling following airway stenting in pediatric patients with tracheobronchial and congenital heart disease","volume":"2","author":"El-Said","year":"2023","journal-title":"J Soc Cardiovasc Angiogr Interv"},{"key":"B18","doi-asserted-by":"publisher","first-page":"963","DOI":"10.1002\/lary.30875","article-title":"Surgical outcomes by early airway endoscopy findings after pediatric staged laryngotracheoplasty","volume":"134","author":"Dabbous","year":"2024","journal-title":"Laryngoscope"},{"key":"B19","doi-asserted-by":"publisher","first-page":"112648","DOI":"10.1016\/j.ijporl.2025.112648","article-title":"The impact of a tracheostomy-safe bronchoscopy protocol on pediatric tracheostomy outcomes","volume":"199","author":"Florentine","year":"2025","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"3530","DOI":"10.1002\/ppul.27247","article-title":"Bronchopulmonary dysplasia and ventilation-associated outcomes after pediatric tracheostomy","volume":"59","author":"Chorney","year":"2024","journal-title":"Pediatr Pulmonol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1002\/ppul.10432","article-title":"Airway inflammation in children with tracheostomy","volume":"37","author":"Griese","year":"2004","journal-title":"Pediatr Pulmonol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1016\/j.bjorl.2020.12.006","article-title":"Complications of tracheostomy in children: a systematic review","volume":"88","author":"Lubianca Neto","year":"2022","journal-title":"Braz J Otorhinolaryngol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1002\/ppul.26766","article-title":"A systematic review of antimicrobial therapy in children with tracheostomies","volume":"59","author":"Pearce","year":"2024","journal-title":"Pediatr Pulmonol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"111821","DOI":"10.1016\/j.ijporl.2023.111821","article-title":"External peri-stomal skin granulations in paediatric tracheostomy: incidence, outcomes and a proposed treatment algorithm","volume":"176","author":"Kawar","year":"2024","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e70245","DOI":"10.1002\/lio2.70245","article-title":"Prevalence, associations, and outcomes of suprastomal collapse after pediatric tracheostomy","volume":"10","author":"Young","year":"2025","journal-title":"Laryngoscope Investig Otolaryngol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"2941","DOI":"10.1002\/lary.31271","article-title":"Pediatric tracheotomy stomal maturation and tracheocutaneous fistulas","volume":"134","author":"Ha","year":"2024","journal-title":"Laryngoscope"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.4187\/respcare.11932","article-title":"Pediatric tracheostomy year in review","volume":"69","author":"Willis","year":"2024","journal-title":"Respir Care"},{"key":"B28","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1177\/08850666231162530","article-title":"Characteristics and outcomes of patients discharged directly home from the pediatric intensive care unit","volume":"38","author":"Pizzuto","year":"2023","journal-title":"J Intensive Care Med"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1485544","DOI":"10.3389\/fpubh.2024.1485544","article-title":"Impact of pediatric tracheostomy on family caregivers\u2019 burden and quality of life: a systematic review and meta-analysis","volume":"12","author":"Aung","year":"2025","journal-title":"Front Public Health"},{"key":"B30","doi-asserted-by":"publisher","first-page":"2001","DOI":"10.1164\/rccm.202508-2055ST","article-title":"Care of infants and children with tracheostomies: an official American thoracic society clinical practice guideline","volume":"211","author":"Amin","year":"2025","journal-title":"Am J Respir Crit Care Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"2473974X211045615","DOI":"10.1177\/2473974X211045615","article-title":"Pediatric tracheostomy outcomes after development of a multidisciplinary airway team: a quality improvement initiative","volume":"5","author":"Chorney","year":"2021","journal-title":"OTO Open"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1880157\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T05:39:09Z","timestamp":1785908349000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1880157\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,5]]},"references-count":31,"alternative-id":["10.3389\/fped.2026.1880157"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1880157","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,5]]},"article-number":"1880157"}}