Cuffed endotracheal tubes in neonates and infants of less than 3 kg body weight-A retrospective audit

BACKGROUND

Large prospective clinical studies have shown that modern cuffed pediatric tracheal tubes can be used safely, even in children weighing ≥3 kg. There is a growing interest in their use in children weighing <3 kg so that they, too, can benefit from the potential advantages, particularly the high probability of these tubes fitting into and sealing the pediatric airway at the first intubation attempt. This study aimed to find a cut-off body weight for procedures requiring a cuffed tracheal tube to seal the airway in children weighing <3 kg and to evaluate the frequency and predictive factors for the requirement to place a cuffed instead of an uncuffed tracheal tube.

METHODS

This study was a retrospective analysis of 269 children weighing 2000-2999 g, primarily intubated by pediatric anesthetists. Frequency of intubation with uncuffed Sheridan tubes versus cuffed Microcuff^® Pediatric Endotracheal Tube (PET) 3.0 mm ID was studied. Predictive variables were assessed by means of logistic regression analysis. The ROC curve for weight at intubation time and Youden index was calculated.

RESULTS

The 149 (55.4%) children were finally intubated with a cuffed tracheal tube. Logistic regression demonstrated that body weight at tracheal intubation and birth weight were the strongest predictors for the appropriateness of cuffed/uncuffed tracheal tubes. The threshold weight at tracheal intubation was 2700 g for a probability >50% of using a cuffed tracheal tube.

CONCLUSION

Half of the children weighing 2000-2999 g received a Microcuff^® PET 3.0 mm ID, especially those with a body weight above 2700 g. Because of the anatomical dimensions in patients with a body weight of 2000-2999 g, cuffed tracheal tubes with smaller outer diameters may be required to better fit their airways.

Clinical performance of cuffed versus uncuffed preformed endotracheal tube in pediatric patients undergoing cleft palate surgery

Background:

Uncuffed endotracheal tubes are commonly used in children but due to several decade preferred in paediatric oral surgery. Due to lack of conclusive evidences in this regard, we have conducted this study to compare post-operative morbidity following use of cuffed and uncuffed endotracheal tubes in paediatric patients undergoing cleft lip-palate surgery.

Methods:

This randomised controlled trial was conducted on children aged 2 to 12 years.110 patients were allocated in two parallel groups using computer generated list of random numbers. Post operative extubation stridor, sore throat, time to first oral intake and regaining of normal voice were compared between two groups.

Results:

The incidence of sore throat was significantly more (P value > 0.005) in patients of uncuffed group compared to cuffed group. The time to first oral intake and time to regain normal voice were significantly earlier in cuffed group compared to the other.

Conclusion:

With standard care, preformed cuffed ET tube has shown reduced incidence of post operative sore throat. Cuffed group has earlier oral intake and normal voice regain compared to uncuffed group.