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Updated: Aug 11, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Evaluation of tracheal intubations in a paediatric intensive care unit
Laura Butragueño-Laiseca1, Laura Torres1, Elena O'Campo1
1Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañon, Madrid, Spain.
Insights
First-attempt tracheal intubation failure is common in critically ill children, often linked to ventilation difficulties. Implementing structured protocols may reduce adverse events during pediatric intubation.
Area of Science:
- Pediatric Critical Care Medicine
- Anesthesiology
- Emergency Medicine
Background:
- Tracheal intubation is a common but high-risk procedure in pediatric intensive care units (PICUs).
- Complications from intubation can significantly increase patient morbidity and mortality.
Purpose of the Study:
- To analyze risk factors associated with failed tracheal intubation in children.
- To identify factors contributing to adverse events during pediatric intubation.
Main Methods:
- Prospective, longitudinal, observational study conducted in a level III PICU.
- Analysis of 48 tracheal intubations performed between January and December 2020.
- Evaluation of indications, success rates, and adverse events, correlating them with procedural factors.
Main Results:
- First-attempt intubation success rate was 60.4%, with no significant difference between staff and resident physicians.
- Difficulty with bag-mask ventilation was a key predictor of first-attempt failure (P = .028).
- Adverse events occurred in 12.5% of intubations (8.3% severe), with multiple attempts significantly associated with adverse events (P < .002).
- Systematic preparation and role allocation independently reduced adverse events.
Conclusions:
- First-attempt tracheal intubation failure is frequent in critically ill children, often predicted by bag-mask ventilation issues.
- A notable proportion of pediatric intubations result in serious adverse events.
- Implementing standardized intubation protocols is crucial for reducing adverse event incidence in PICUs.
Introduction:
Tracheal intubation is a frequent procedure in paediatric intensive care units (PICUs) that carries a risk of complications that can increase morbidity and mortality.
Patients And Methods:
Prospective, longitudinal, observational study in patients intubated in a level III PICU between January and December 2020. We analysed the risk factors associated with failed intubation and adverse events.
Results:
The analysis included 48 intubations. The most frequent indication for intubation was hypoxaemic respiratory failure (25%). The first attempt was successful in 60.4% of intubations, without differences between procedures performed by staff physicians and resident physicians (62.5% vs 56.3%; P = .759). Difficulty in bag-mask ventilation was associated with failed intubation in the first attempt (P = .028). Adverse events occurred in 12.5% of intubations, and severe events in 8.3%, including 1 case of cardiac arrest, 2 cases of severe hypotension and 1 of oesophageal intubation with delayed recognition. None of the patients died. Making multiple attempts was significantly associated with adverse events (P < .002). Systematic preparation of the procedure with cognitive aids and role allocation was independently associated with a lower incidence of adverse events.
Conclusions:
In critically ill children, first-attempt intubation failure is common and associated with difficulty in bag-mask ventilation. A significant percentage of intubations may result in serious adverse events. The implementation of intubation protocols could decrease the incidence of adverse events.
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