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To assess the frequency of complications of endotracheal intubation and mechanical ventilation.Prospective cohort study.Pediatric tertiary multidisciplinary ICU.Eight hundred sixty-nine serial patients, of whom 500 were endotracheally intubated and 431 were mechanically ventilated.Daily clinical observation.Age, diagnosis, endotracheal tube size, type of ventilator and humidification, duration of intubation and mechanical ventilation, ventilatory settings, and complications (accidental extubation, tissue damage, endobronchial intubation, postintubation stridor, endotracheal tube blockage, pulmonary airleak, bronchopulmonary dysplasia, pulmonary atelectasis) were recorded.The median patient age was 10 months (25th and 75th quartiles: 1 month and 15 yrs). The median duration of endotracheal intubation and mechanical ventilation was 4 days and 2 days, respectively. A total of 186 complications were recorded in 119 (24%) patients. No deaths were due to intubation or ventilation. The overall frequency of accidental extubation was 3.2% of patients at a rate of 1.26 extubations/100 intubation days. In nonventilated, unsedated patients with croup or epiglottitis, the frequency of accidental extubation was 23% at a rate of 11.83 extubations/100 intubation days. Lung atelectasis occurred in 7.8%, airleak in 6.8%, and infection in 2.3% of patients. Other complications included tissue damage (3.4%), endobronchial intubation (2.4%), postintubation stridor (2.4%), bronchopulmonary dysplasia (2.3%), and endobronchial tube blockage (0.8%).Complications were related to the duration of intubation and mechanical ventilation.