Abstract
Objective
This study aims to systematically review all adverse events (AEs) associated with orotracheal intubation in pediatric patients, with the ultimate goal of aiding healthcare center administration in establishing evidence-based guidelines and devising preventive strategies to mitigate AEs in pediatric intubation procedures.
Methods
Systematic automated searches across pivotal databases were conducted up to 2023. The screening process was facilitated by EndNote X9 following the importation of citations. Data extraction was guided by predefined eligibility criteria after the elimination of duplicates and ineligible publications. The National Institutes of Health (NIH) quality evaluation instrument was employed to assess biases.
Results
A total of twenty-four studies spanning from 2002 to 2023, encompassing 7135 patients were included in the analysis. Among the identified adverse events, moderate desaturation(≤90%) emerged as the most prevalent, affecting 508/2398 (23.9%, 95% CI: 17.6% to 30.3%) of cases across 13 studies. Mainstem intubation was observed in 342 out of 4,481 cases (9.1%, 95% CI: 6.3% to 11.9%) and in 173 out of 3903 cases (3.9%, 95% CI: 2.5% to 5.3%), making these significant AEs. Cardiac complications, including arrhythmias 55/3858 (1.2%, 95% CI: 0.6% to 1.8%), hypotension 121/4536 (2.6%, 95% CI: 1.5% to 3.7%), and cardiac arrest 105/4836 (1.4%, 95% CI: 0.7% to 2.2%), were observed in 10, 11, and 11 trials, respectively. Severe complications, with an incidence rate of 274/3298 (8.8%, 95% CI: 4.2% to 13.3%), were reported in five studies.
Conclusion
This comprehensive investigation and subsequent meta-analysis of adverse events associated with pediatric intubation provide valuable insights that can inform the development of enhanced safety protocols and evidence-based guidelines for pediatric emergency care.
Impact
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High Success Rate with Complications: An 84.7% intubation success rate is reported, with a 30.1% complication rate, including desaturation, mainstem and esophageal intubation, and cardiac issues.
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Need for Enhanced Safety Measures: Findings stress the importance of better training and standardized protocols to reduce complications in pediatric emergency intubation.
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Focus on Adverse Events: This study uniquely highlights adverse events, offering crucial data for developing guidelines to improve safety in pediatric intubation.
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Data availability
The dataset supporting the conclusions of this article is included within the article and its Supplementary file 1.
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Acknowledgements
The authors would like to thank Mahmoud M. Elhady; Faculty of Medicine, Benha university, Qalubiya, Egypt, email: [email protected] for his help.
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Mohammed Alsabri (M.A.) and Mohammed Sayed Aazoue (M.S.Z.) are considered co-first authors. M.A. proposed the project, wrote the protocol, participated in the screening and selection of studies, contributed to the conception and formulation of the article, and drafted, reviewed, and revised the manuscript. M.S.Z. contributed significantly to the protocol, conducted the search strategy, assisted with data analysis, and participated in the screening and selection of studies alongside Ala Ahmed (A.A.). Mohammed Al-Tawil (M.A.T.) and Ibrahim Kamal (I.K.) were involved in data extraction, quality assessment, and critical revision of the manuscript. I.K. also conducted the data analysis and contributed to the writing and revision of the final manuscript. In cases of discrepancies during data extraction or assessment, M.A. resolved the conflicts. E.B., A.Z., A.B., J.C., and M.S. provided substantial input in writing and revising the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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Alsabri, M., Kamal, I., Al-Tawil, M. et al. Adverse events in pediatric orotracheal intubation in the pediatric emergency department: systematic review and meta-analysis. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04142-6
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DOI: https://doi.org/10.1038/s41390-025-04142-6
