Cuffed tracheal tubes: guilty now proven innocent

Shah, Akshay; Carlisle, J. B.

doi:10.1111/anae.14787

Cited by 8 publications

(12 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Since their introduction in 2006, Microcuff ETTs have been associated with fewer perioperative respiratory complications and tube exchanges than uncuffed tubes (Weiss et al, 2006;Chambers et al, 2018;Shah & Carlisle, 2019). A survey conducted in 2017 demonstrated that only 29% of UK cleft surgeons had experience with microcuffed ETTs.…”

Section: Discussionmentioning

confidence: 99%

The Throat Pack Debate: A Review of Current Practice in UK and Ireland Cleft Centers

Curran

Narayan

Fenner

et al. 2021

The Cleft Palate-Craniofacial Journal

View full text Add to dashboard Cite

Introduction: The use of throat packs during oropharyngeal surgery has long been a topic of debate among cleft surgeons. The advantage of inserting an absorbent tulle within the pharynx must be weighed against the risk of unintended retention postoperatively. Despite safety check mechanisms in place, retention may occur with potentially life-threatening consequences. We present a comprehensive review of throat pack use in all cleft units within the United Kingdom and Ireland. Methods: All 20 cleft surgery units in the United Kingdom and Ireland were surveyed on their use of throat packs in children aged 6 months to 2 years undergoing elective cleft palate surgery. Results: The response rate to the survey was 100%. Seventy-five percent of units currently use throat packs; in 40%, they are used in addition to cuffed endotracheal tubes (ETTs). Inclusion of the throat pack in the surgical swab count was perceived as the safest mechanism employed to avoid retention. 26.1% of respondents were aware of at least 1 incident of pack retention in their unit. Discussion/Conclusion: The reported UK and Irish experience demonstrates that three-quarters of units routinely use packs. Notably, a quarter of respondents to the survey have experience of an incident of throat pack retention. Nevertheless, the majority of respondents considered the perceived risk of retaining a pack to be low. The growing use of microcuffed ETTs in UK cleft units paired with a low incidence of perioperative complications when a throat pack is not introduced might prompt cleft surgeons to review routine pharyngeal packing.

show abstract

Section: Discussionmentioning

confidence: 99%

The Throat Pack Debate: A Review of Current Practice in UK and Ireland Cleft Centers

Curran

Narayan

Fenner

et al. 2021

The Cleft Palate-Craniofacial Journal

View full text Add to dashboard Cite

show abstract

“…The recommendation for uncuffed tubes is to choose the size that will pass through the subglottic area and lead to the adequate seal of the system without damaging the airway mucosa. The aim to reach the seal up to 20–30 cm H 2 O of peak inspiratory pressure [ 8 ], and the leak over 20–30 cm H 2 O was considered as safety aspect (explained by a certain superstition that the leak will guarantee no/minimal tube-to-mucosa contact/damage). This, however, could not be carried out effectively/safely due to the airway anatomy described above (elliptical shape of subglottic area).…”

Section: Uncuffed Vs Cuffed Tubesmentioning

confidence: 99%

“…In the recent two decades, several articles revealing the lower incidence of postextubation stridor with cuffed tubes have been published [ 5 , 6 , 7 ]. Extensive anatomical research (real-time bronchoscopy, computed tomography and magnetic resonance imaging) revealed that the originally thought circular-shaped subglottic area is in reality elliptical, with a wide anteroposterior diameter and narrow transverse diameter [ 8 , 9 , 10 , 11 ]. These findings could explain the risk of postextubation stridor even with the properly placed uncuffed tube, which could severely damage the mucosa in the transverse edges of the subglottic region.…”

Section: Introductionmentioning

confidence: 99%

Airway Management in Pediatric Patients: Cuff-Solved Problem?

et al. 2022

View full text Add to dashboard Cite

Traditionally, uncuffed tubes were used in pediatric patients under 8 years in pursuit of reducing the risk of postextubation stridor. Although computed tomography and magnetic resonance imaging studies confirmed that the subglottic area remains the narrowest part of pediatric airway, the use of uncuffed tubes failed to reduce the risk of subglottic swelling. Properly used cuffed tubes (correct size and correct cuff management) are currently recommended as the first option in emergency, anesthesiology and intensive care in all pediatric patients. Clinical practice particularly in the intensive care area remains variable. This review aims to analyze the current recommendation for airway management in children in emergency, anesthesiology and intensive care settings.

show abstract

“…BALONKOVÉ TRACHEÁLNÍ ROURKY -"VINÍK" OSVOBOZEN [17] Kontroverze týkající se použití balónkových a bezbalónkových tracheálních rourek je dlouhodobá a historicky založena spíše na názorech než na vědeckých datech. Chambers et al [18] v prospektivní randomizované studii prokázali, že ventilace pediatrických pacientů při zajištění dýchacích cest pomocí balónkových tracheální rourek je efektivnější a vede k redukci perioperačních respiračních komplikací.…”

Section: Ketamin V Nízkých Dávkách U Ortopedických Operací [16]unclassified