Thomas RE, Erickson S, Hullett B, Minutillo C, Lethbridge M, Vijayasekaran S, Agrawal S, Bulsara MK, Rao SC. Comparison of the efficacy and safety of cuffed versus uncuffed endotracheal tubes for infants in the intensive care setting: a pilot, unblinded RCT.
Arch Dis Child Fetal Neonatal Ed 2021;
106:614-620. [PMID:
33879529 DOI:
10.1136/archdischild-2020-320764]
[Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/25/2021] [Accepted: 04/06/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE
To study effectiveness and safety of cuffed versus uncuffed endotracheal tubes (ETTs) in small infants in the intensive care unit (ICU).
DESIGN
Pilot RCT.
SETTING
Neonatal and paediatric ICUs of children's hospital in Western Australia.
PARTICIPANTS
Seventy-six infants ≥35 weeks gestation and infants <3 months of age, ≥3 kg.
INTERVENTIONS
Patients randomly assigned to Microcuff cuffed or Portex uncuffed ETT.
MAIN OUTCOMES MEASURES
Primary outcome was achievement of optimal ETT leak in target range (10%-20%). Secondary outcomes included: reintubations, ventilatory parameters, ventilatory complications, postextubation complications and long-term follow-up.
RESULTS
Success rate (achievement of mean leak in the range 10%-20%) was 13/42 (30.9%) in the cuffed ETT group and 6/34 (17.6%) in uncuffed ETT group (OR=2.09; 95% CI (0.71 to 6.08); p=0.28). Mean percentage time within target leak range in cuffed ETT group 28% (IQR: 9-42) versus 15% (IQR: 0-28) in uncuffed ETT group (p=0.01). There were less reintubations to optimise size in cuffed ETT group 0/40 versus 10/36 (p<0.001). No differences were found in gaseous exchange, ventilator parameters or postextubation complications. There were fewer episodes of atelectasis in cuffed ETT group 0/42 versus 4/34 (p=0.03). No patient had been diagnosed with subglottic stenosis at long-term follow-up.
CONCLUSIONS
There was no difference in the primary outcome, though percentage time spent in optimal leak range was significantly higher in cuffed ETT group. Cuffed ETTs reduced reintubations to optimise ETT size and episodes of atelectasis. Cuffed ETTs may be a feasible alternative to uncuffed ETTs in this group of patients.
TRIAL REGISTRATION NUMBER
ACTRN12615000081516.
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