The Complication Profile and Contributing Factors in Adverse Events of Endotracheal Intubation in a Paediatric Intensive Care Unit of Karachi, Pakistan

Abstract

Background: Endotracheal intubation (ETI) is an essential and potentially life-saving procedure in pediatric intensive care units (PICUs). Despite its importance, the technique is associated with notable risks, particularly in children, who are more vulnerable to complications because of their distinct anatomical and physiological characteristics. Data from these studies indicate that adverse events are frequent, with approximately one in five intubations complicated by some form of tracheal intubation–associated event. Current study was designed to assess the frequency and nature of ETI-related complications in children admitted to the PICU. Methods: A cross-sectional study was conducted in the Pediatric Intensive Care Unit of the Indus Hospital Karachi, from September 2024 to February 2025. The data collected encompassed a wide range of variables, including patient demographics like age, weight and gender, the primary diagnosis at hospital admission, details of intubation like number of attempts, type, size of tube and time of intubation either in morning or night hours, monitoring and checklist according to RSI. Additionally, unfavorable effects at pre-intubation, during intubation and post-extubation were checked. Cardiac arrest, bradycardia, hypoxia, esophageal intubation with or without observed aspiration, direct airway injury, dental and perioral trauma, bronchial intubation was systematically recorded as well as the outcomes of the patients in terms of LOS, duration of MV and patient’s survival were also noted. Data was collected and analyzed by using Statistical Package for Social Science (SPSS) version 23. Results: The mean age of the study participants was 5.7 ± 4.8 years while the mean weight was 18.2 ± 14.6kg. The main indication for intubation was of respiratory cause (67%) while the non-respiratory causes (31.8%) were cardiac (3.4%), post-operative (3.4%), shock (8%) and neurological (19.3%). About 74.7% study participants were intubated in first attempt. Looking over the adverse events, none of the study participant had dental trauma or vocal cord palsy. About 5 (5.7%) patients faced perioral laceration, 10 (11.4%) patients had bronchospasm, 2 (2.3%) had esophageal intubation, 4 (4.5%) had cardiac arrest, 1 (1.1%) had aspiration into lungs, 8 (9.1%) had hypotension, 13 (14.8%) had bradycardia. Other adverse events included desaturation hypoxia in 21 (23.9%), unexplained extubation in 5 (5.7%), tube blockage in 11 (12.5%), endobronchial intubation in 1 (1.1), stridor in 2 (2.3%) and hoarseness of voice in 3 (3.4%) patients but the study found good patient’s outcome after intubation. Conclusion: It can be concluded that the main indication for intubation was of respiratory cause (67%) and 74.7% study participants were intubated in first attempt. Adverse tracheal intubation–associated events are frequently observed during intubation of critically ill children admitted in PICU. Desaturation hypoxia was the most frequent adverse event (23.9%) followed by bradycardia (14.8%), tube blockage (12.5%), bronchospasm (11.4%) and hypotension (9.1%).