Pediatric patients who underwent two or more tracheal intubations experienced a high failure rate and an increased risk for complications, according to research published in The Lancet.

The researchers found that first attempts at intubation with indirect video laryngoscopy were successful in 55% (n = 101) of cases, whereas attempts with fiber optic bronchoscopy and direct laryngoscopy were successful in 54% (n = 153) of cases and 3% (n = 30) of cases, respectively. The intubation failed in 2% (n = 19) of cases, according to the abstract.

Two hundred four patients experienced complications, with 3% (n = 30) of patients reporting severe complications and 19% (n = 192) of patients reporting non-severe complications.

“This high complication rate is multifactorial in origin. The patient-level factors include abnormal airway physical examination and lower patient age and weight. Process factors included multiple tracheal intubation attempts and multiple direct laryngoscopy attempts,” researchers wrote.