Time to Tube: Does a Checklist Make Intubations Better, Faster, Safer?

Introduction: Intubation in the pediatric intensive care unit (PICU) is a high-risk procedure requiring rapid coordination, clear communication, and reliable access to equipment. Our project aimed to promote utilization of an intubation checklist to reduce adverse events associated with intubations over a 2-month period in summer 2025. We predicted that the process would increase intubation safety and success without adding time to intubation.


Methods: A multidisciplinary team of PICU fellows, attendings, respiratory therapists (RTs), and nurses (RNs) developed a checklist encompassing personnel roles, safety considerations, room setup, and required equipment. During implementation, team champions were present in the unit to ensure fidelity to the process and evaluate barriers. Checklists were placed in each patient room and on airway carts. Procedure and resuscitation records were reviewed to confirm checklist use as a process measure, adverse events, and duration from time out to intubation. Adverse events (AEs) were categorized as hypoxemia (oxygen desaturation < 80%), non-severe (mainstem intubation, emesis without aspiration), severe (emesis with aspiration), and multiple attempts. A post-intervention survey was disseminated to all PICU team members to assess utility of the checklist, as well as perceived impacts on patient care.


Results: The checklist was utilized in 85% of intubations during the study period; the most common barrier was the procedure being too emergent. The rate of intubations complicated by AEs decreased in number and severity following checklist implementation without prolonging time to intubation. Survey respondents reported that the checklist improved safety, supported a shared mental model, decreased cognitive burden, and helped identify equipment gaps. No participants felt it detracted from autonomy or was unnecessary. Ninety percent of respondents supported continued checklist use.


Conclusions: Implementation of a standardized intubation checklist was feasible and well-received in the PICU. It reduced adverse events. Users reported improved safety, team coordination, and reduced cognitive load. These findings support a standardized intubation process involving checklist use to build teamwork and promote a shared mental model during a complex event.