[Complications of tracheal intubation in pediatrics]

Abstract

Objective: To describe the frequency and types of tracheal intubation complications and their main causes.

Methods: Cross sectional study of patients who were submitted to tracheal intubation for more than 24 hours at the Pediatric ICU of Santa Casa de Misericórdia de São Paulo, between May 1998 and December 1999. Exclusion criteria were previous intubations, surgeries or traumas in the cervical region or oropharynx.

Results: A study of 147 patients with ages varying from 1 month to 15 years and 3 months was carried out. An inadequate tracheal tube had been used in 31.3% of patients submitted to tracheal intubation and 14.3% needed 5 or more attempts to achieve intubation. Resident physicians had more difficulty with intubation. Most tracheal intubation attempts were related to increased traumas, hypoxia, bradycardia and worsening of the Downes score after extubation. Accidental extubation was observed in 21.8%, related to worsening in the score of Downes and need for reintubation. The resident physicians also caused a higher number of traumas and bradycardia.

Conclusion: Most complications may be attributed to lack of experience and training of the physician performing the tracheal intubation. We should implement training programs and increase supervision during tracheal intubation to minimize these outcomes.