Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 02 25 1458 1458 Cristian Pirade Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Sutji Pratiwi Rahardjo Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Rafidawaty Alwi Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Muh. Fadjar Perkasa Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Arifin Seweng Department of Biostatistics, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia. 2025 10 22 2025 11 08 Background: Tracheostomy is a critical procedure for airway management in mechanically ventilated patients, yet its biological impact on systemic inflammation remains unclear. Procalcitonin (PCT), a biomarker of bacterial infection and inflammatory activity, provides valuable insight into infection dynamics in critically ill patients. This study sought to examine fluctuations in serum PCT levels before and after tracheostomy in ICU patients to evaluate inflammatory responses and potential advantages in infection management. Methods: Between January and July 2025, a prospective cohort study was done in three tertiary ICUs in Makassar, Indonesia. Twenty adult patients need extended mechanical ventilation received tracheostomy. We checked serum PCT levels four times: one day before the tracheostomy (H−1) and on days 3, 5, and 7 after the surgery. We used the Friedman and Least Significant Difference (LSD) tests to look at the data. The cutoff for significance was p < 0.05. Results: The average PCT levels dropped dramatically from 13.52 ± 22.86 ng/mL (H−1) to 6.64 ± 14.13 ng/mL (H+3; p = 0.048). They then progressively went back up on days 5 and 7. Younger patients (under 50 years old) and those who were intubated for a shorter duration (7 days or fewer) showed better PCT patterns, which implies that there was less inflammation after early tracheostomy. Conclusion: Tracheostomy was associated with a transient reduction in systemic inflammation, seen by decreased PCT levels by the third day post-procedure. The later rise in PCT suggests possible secondary infection or inflammatory rebound. Early tracheostomy and serial PCT monitoring are recommended to enhance infection control and optimize ICU outcomes. https://aacc.tums.ac.ir/index.php/aacc/article/view/1458