April 8, 2024

Avoid damage due to intubation

The ERC guidelines point out that only experienced persons should attempt to intubate a child prehospital. This applies not only to the intubation procedure, but also to experience with the dosage and properties of the medication used1!

Even in the event of resuscitation, polytrauma or intracranial pressure, children do not benefit from endotracheal intubation! Aspirations pose little threat in childhood, but damage caused by hypoxia is very serious! Therefore, intubation should never be forced desperately. Supraglottic airway devices should be used instead. For the same reason, intermediate ventilation should always be performed for intubation in a non-sober child2.

However, if endotracheal intubation is to be performed, these are the most important rules for avoiding intubation damage and complications:

Safety in the selection of the appropriate tube size is provided by Table 1 or the use of the Pediatric Emergency Ruler PedNFL for the demonstrably most precise estimation of the tube size3.

If, despite the above precautions, stridor occurs after extubation and does not stop after inhalation of ß-mimetics and administration of corticosteroids, an endoscopy of the larynx should be performed quickly. With the transglottic injection of a depot corticosteroid, 80% of severe damage that would otherwise have required a tracheostomy can be cured

Intubation trauma can be healed by a rapid transglottic injection of cortisone, thus avoiding a tracheostomy.

Table 1:


  1. Van de Voorde P, Turner NM, Djakow J et al. European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation 2021; 161: 327-387, DOI: 10.1016/j.resuscitation.2021.02.015.
  2. Schmidt J, Strauß JM, Becke K. Recommendations for rapid sequence induction in children. Anaesth Intensivmed 2007; 48: S88-93
  3. Hofer CK, Ganter M, Tucci M et al. How reliable is length-based determination of body weight and tracheal tube size in the paediatric age group? The Broselow tape reconsidered. Br J Anaesth 2002; 88: 283-285
  4. Kaufmann J, Bode K, Puder C et al. Transglottic corticosteroid injection for treatment of soft post-intubation subglottic stenosis: a retrospective analysis of 26 children. Eur Arch Otorhinolaryngol 2019; 276: 3419-3424, DOI: 10.1007/s00405-019-05642-y

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