The use of cuffed versus uncuffed endotracheal tubes in pediatric intensive care

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Abstract

Objective

To report our experience with cuffed endotracheal tubes (ETT) in a large cohort of critically ill children.

Study design

We prospectively collected data over a 1-year period concerning long-term intubation on 860 critically ill children admitted to our intensive care unit. Tube sizes were dictated by the modified Cole formula for uncuffed ETT (age [y]/4 + 4 mm ID) and chosen one-half size less for cuffed ETT. Cuff pressure was regularly monitored to maintain a small leak at peak inspiratory pressure. The choice of ETT was made by the physician responsible for the initial airway management.

Results

There were 597 patients in the first 5 years of life, with 210 having cuffed ETT. There were no significant differences in the use of racemic epinephrine for postextubation subglottic edema, the rate of successful extubation or the need for tracheotomy between those with cuffed and uncuffed ETT in any age group.

Conclusions

Our data suggest that the traditional teaching in pediatric anesthesia and intensive care, including current pediatric life support recommendations, need to be reviewed for children to benefit from the advantages of modern low-pressure cuffed ETT during critical illnesses.

Section snippets

Methods

Data were gathered over a 12-month period on all intubated medical and surgical patients admitted to a 20-bed multidisciplinary intensive care unit and a 15-bed cardiothoracic intensive care unit. Fifty-five percent of the patients admitted during this period were intubated, and there were 860 episodes of patient intubation. Patients' ages ranged from 1 day to 30 years. There were 377 cardiac cases and 483 noncardiac patients. Data collected included the patient's age, weight, and diagnosis.

Results

There were 860 episodes of intubation and extubation (Table I). The overwhelming majority of ETT were manufactured by Mallinckrodt (Nellcor, Pleasanton, Calif). Overall, extubation was successful on the first attempt in 92.7% of patients (ie, failed extubations were 7.3%, or 1.3 per 100 days of mechanical ventilation). There were 597 patients younger than 5 years of age, with 210 having a cuffed ETT and 387 having an uncuffed ETT (see Table II). Overall, patients with cuffed ETT spent

Discussion

Our study demonstrates that cuffed ETT can be safely used for prolonged periods of time without causing short- or long-term side-effects. Our data showed that the practice of using cuffed ETT on appropriate occasions in the pediatric patient population has not declined over the intervening years since our first study9 and has become the standard of care in our intensive care units and in others.12 Indeed, judging by the PRISM score (a pediatric risk of death index scored at the end of the first

References (27)

  • W.L. Guess et al.

    Tissue reactions to organotin-stabilized polyvinyl chloride (PVC) catheters

    JAMA

    (1968)
  • F. Cole

    Pediatric formulas for the anesthesiologist

    Am J Dis Child

    (1957)
  • R.E. Schwartz et al.

    Tracheal tube leak test: is there interobserver agreement?

    Can J Anaesth

    (1993)
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