Comparison of drugs used for intubation of pediatric trauma patients

J Pediatr Surg. 2020 May;55(5):926-929. doi: 10.1016/j.jpedsurg.2020.01.041. Epub 2020 Jan 31.


Purpose: Rapid sequence intubation (RSI) drugs, such as propofol, affect clinical outcomes, but this has not been examined in the pediatric population. This descriptive study compares the outcomes associated with intubation drugs used in pediatric traumatic brain injury (TBI) patients.

Methods: A retrospective chart review and descriptive analysis of intubated TBI patients, ages 0-17, admitted to Children's Hospital London Health Sciences Centre (LHSC) from January 2006-December 2016 was performed.

Results: Out of 259 patients intubated, complete data was available for 107 cases. Average injury severity score was 28; 46 were intubated at LHSC, 55 at primary care site, and 6 on scene. Intubation attempts were recorded in 87 of 107 paper charts. First-pass intubation success rate was 88.5%. Propofol (n = 21), midazolam (n = 31), etomidate (n = 13), and ketamine (n = 7) were the most commonly used intubation drugs. Paralytics were used in 50% of patients. Following use of propofol, Pediatric Adjusted Shock Index was increased as a result of worsening hypotension. Mean total hospital length of stay was 21 days with 7.5 days in ICU. Survival was 87%.

Conclusion: Great variability exists in the use of induction agents and paralytics for RSI. Propofol was commonly used and is potentially associated with poorer clinical outcomes.

Type of study: Retrospective.

Level of evidence: IV.

Keywords: Pediatric; Propofol; Rapid sequence intubation (RSI); Trauma; Traumatic brain injury (TBI).

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Brain Injuries, Traumatic / therapy*
  • Child
  • Child, Preschool
  • Etomidate / administration & dosage
  • Female
  • Hospitals, Pediatric
  • Humans
  • Hypnotics and Sedatives / administration & dosage*
  • Hypnotics and Sedatives / adverse effects
  • Hypotension / epidemiology
  • Infant
  • Infant, Newborn
  • Injury Severity Score
  • Ketamine / administration & dosage
  • Length of Stay
  • London
  • Male
  • Midazolam / administration & dosage
  • Propofol / administration & dosage
  • Propofol / adverse effects*
  • Rapid Sequence Induction and Intubation / methods*
  • Retrospective Studies
  • Shock


  • Hypnotics and Sedatives
  • Ketamine
  • Midazolam
  • Propofol
  • Etomidate