Indications for Endotracheal Intubation in Children

What are the indications to intubate the trachea of a child?

  • • Respiratory failure that is unlikely to be reversed quickly, especially if hypoxemia is present despite greater than 60% oxygen administration
  • • Apnea, hypoventilation, or progressive respiratory exhaustion that requires ongoing mechanical ventilation
  • • Need for airway protection for children who have upper airway obstruction or an inability to protect their airway from aspiration
  • • Desire to decrease the work of breathing for patients in shock (under normal circumstances, work of breathing requires less than 5% of the total energy expenditure, but with respiratory distress it can demand up to 50%; in a shock state, energy can be better utilized for other essential body functions)
  • • Therapeutic interventions, such as tracheal administration of medications and suctioning for pulmonary toilet (mechanical ventilation is also required)

Indications for Endotracheal Intubation

  • 1. Progressive respiratory exhaustion—unlikely to reverse quickly
  • 2. Apnea, hypoventilation that requires mechanical ventilation
  • 3. Need for airway protection (upper airway obstruction, loss of protective airway reflexes)
  • 4. Shock
  • 5. Airway access for pulmonary toilet


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