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Emergency endotracheal intubation in children

Joshua Nagler, MD
Section Editor
Anne M Stack, MD
Deputy Editor
James F Wiley, II, MD, MPH


This topic will focus on the procedure of oral endotracheal (ET) intubation with traditional direct laryngoscopy in children. Direct laryngoscopy and tracheal intubation in adults is reviewed separately, as is videolaryngoscopy in children. (See "Direct laryngoscopy and endotracheal intubation in adults" and "Devices for difficult endotracheal intubation in children", section on 'Video laryngoscope'.)

Basic airway maintenance techniques for children and adults that assess the need for airway support, rapid sequence intubation, and the difficult pediatric airway are also discussed separately. (See "Basic airway management in children" and "Basic airway management in adults" and "Initial assessment and stabilization of children with respiratory or circulatory compromise" and "Rapid sequence intubation (RSI) outside the operating room in children: Approach" and "The difficult pediatric airway".)


Emergency endotracheal intubation may be performed in the prehospital setting, as well as in emergency departments or other critical care settings. The need for intubation may be immediately apparent, such as in cardiopulmonary arrest. In other circumstances, the decision to intubate may result from dynamic assessment based on progressive or anticipated deterioration despite maximal medical therapies and non-invasive respiratory support.

Emergency intubation is inherently more difficult to perform than planned intubation in the operating room. Patients are not prescreened and often had recent oral intake as opposed to being in the fasted state (ie, nil per os [NPO]). In addition, rapid clinical deterioration may compromise preparation time, and underlying illness or injury may make patients more susceptible to the adverse physiologic effects of this procedure.


There are numerous disease processes and clinical situations that may necessitate intubation. (See "Acute respiratory distress in children: Emergency evaluation and initial stabilization".)

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Literature review current through: Nov 2017. | This topic last updated: Dec 04, 2017.
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