In a prospective multiple trauma study lasting from 1986 to 1991 the influence of early intubation (EI) within 2 h after the accident on posttraumatic (multiple) organ failure (M)OF was compared with that of delayed intubation (DI) in 131 patients with multiple injuries (ISS 37). The indications for intubation were unconsciousness following severe head injury in 45 cases (45 EI, 0 DI), major chest trauma (AIS > or = 3) in 40 (31 EI, 9 DI) and other severe injuries (no head or chest trauma, but ISS > 24) in 40 patients (30 EI, 10 DI). One hundred and six trauma victims (81%) were intubated early and 19 patients (14.5%) required intubation and artificial ventilation in the later course, whereas in 6 subjects (4.5%) spontaneous respiration was adequate. The pattern of injured body regions did not differ substantially between the two groups, but the severity of injury was significantly greater (p < 0.001) in the EI group (ISS 39) than in the DI patients (ISS 29). Among the EI patients, 67% developed at least one OF, 45% respiratory failure (RF), and 28% multiple organ failure (MOF); 15% died. The DI group showed almost the same incidence of RF (42%) and other OF (63%), and even a higher (n.s.) incidence of MOF (37%) and mortality rate (26%). In view of the significantly less severe injuries in the DI group, the observed OF and mortality rates are inappropriately high compared with the incidence of OF and death in the EI group.(ABSTRACT TRUNCATED AT 250 WORDS)