Cuffed pediatric endotracheal tubes—Outer cuff diameters compared to age‐related airway dimensions

Abstract

Background: Reliable sealing of the pediatric airway requires appropriately sized tracheal tube cuffs. The aim of this study was to compare residual cuff diameters of pediatric tracheal tubes with pediatric airway dimensions. Methods: Cuff diameters of five different brands of locally marketed pediatric cuffed tracheal tubes with internal diameters of 3.0-7.0 mm were measured at a cuff pressure of 20 cm H 2 O and compared with cuff diameters indicated by their manufacturers. The latter values were compared to tracheal dimensions using the Motoyama and Khine formulas for cuffed tracheal tube size selection.Results: There is considerable heterogeneity in cuff diameters among pediatric tracheal tube brands, except for two brands from different manufacturers (Halyard and Parker Medical) which were identically designed. Cuffs made from polyurethane revealed fewer differences (91%-118%) between measured and manufacturer-indicated values for outer cuff diameters than did those made from polyvinylchloride (91%-146%).Particularly in smaller sized tracheal tubes, cuffs did not reach 100% of the tracheal lateral diameter, while others were oversized in larger tracheal tubes, independent of the two formulas used for cuffed tracheal tube size selection. Cuff diameters indicated by the manufacturer corresponded to 86%-188% of the median and 68%-157% of the maximum mid-tracheal lateral diameter of the corresponding upper age range. Conclusion:Our findings show that many of the cuff diameters of currently marketed tracheal tube brands lack an age-related anatomical rationale. A proposal for agerelated anatomically based cuff diameters is provided for both recommendations for cuffed tracheal tube size selection in children. K E Y W O R D S airway, airway equipment, pediatric | 425 FISCHER Et al. S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Fischer M, Grass B, Kemper M, Weiss M, Dave MH. Cuffed pediatric endotracheal tubes-Outer cuff diameters compared to age-related airway dimensions. Pediatr

Prediction of endotracheal tube size using a printed three-dimensional airway model in pediatric patients with congenital heart disease: a prospective, single-center, single-group study

“…This is because even ETTs of the same inner diameter have different outer diameters depending on the manufacturer. Cuffed and uncuffed ETTs with 0.5 mm difference in inner diameter, which are clinically considered the same size ETTs, did not lead to the same results in the air leak test in clinical practice [ 22 ]. Fifth, we do not have a compliant material similar to the patients’ airway, and the printed 3D airway model is less compliant after printing and fixing in room temperature.…”

“…Fourth, although this study did not present the results of the best fit ETTs because of minimization of re-intubation, there is a possibility that the replaced 0.5 mm smaller or larger ETT also would not pass the air leak test. This is because even ETTs of the same inner diameter have different outer diameters depending on manufacturer, and cuffed and uncuffed ETTs with 0.5 mm difference in inner diameter, which are clinically considered the same size ETTs, did not lead to the same results in the air leak test in clinical practice [22]. Fifth, we don't have compliant material similar to patients' airway, and printed 3D airway model is less compliant after print and fix in room temperature.…”

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

“…One such factor could be the large variability in the internal diameter of the cricoid 21,22 . Furthermore, the uncuffed tracheal tube 3.0 mm ID (Sheridan) used in our study population has an outer diameter (OD) of 4.0 mm, while the OD of the Microcuff ® PET 3.0 mm ID is 4.3 mm plus the cuff bulk 23 . This means that exchanging an uncuffed tracheal tube with a large air leak for a Microcuff ® PET 3.0 mm ID, despite deflated cuff, may already result in failing the air leak test at an inspiratory pressure of 20 cmH 2 O. Consequently, in future, for cuffed tracheal tubes of size 3.0 mm ID, the tube OD must be smaller and the cuff and depth mark design adapted to the airway anatomy of this group of children in order to allow them to benefit from the advantages of a cuffed tracheal tube, that is, a good fit and, secondarily, a sufficient seal.…”

Insertion of cuff inflation line into pediatric tracheal tubes related to oral and nasal tracheal intubation depth

“…They mainly relate to the dimension, position, and characteristics of the tracheal tube cuffs, to the position of depth markings, and to the problems with internal and outer diameters of cuffed tracheal tubes. [3][4][5][6][7][8] So far, problems related to the cuff inflation line have only occasionally been reported. In clinical practice, clinicians have become accustomed to the fact that the cuff inflation line often interferes with securing the tracheal tubes with tapes or while changing the tapes.…”

“…In the past, however, several shortcomings of the design of cuffed pediatric tracheal tubes have been published. They mainly relate to the dimension, position, and characteristics of the tracheal tube cuffs, to the position of depth markings, and to the problems with internal and outer diameters of cuffed tracheal tubes 3‐8 …”