Cuffed versus uncuffed endotracheal tubes for general anaesthesia in children aged eight years and under

Orange, Flávia Augusta de; Lemos, Andréa; Hall, Amber M.; Borges, Paulo Sgn; Figueirôa, José Natal; Kovatsis, Pete G.

doi:10.1002/14651858.cd011954

Cited by 20 publications

(26 citation statements)

References 31 publications

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“…Tracheal intubation particularly in small children is a challenging procedure and successful tracheal tube insertion through the vocal cords should entail both a gentle laryngeal passage and a sufficient tracheal seal, once inflated . A too small tracheal tube cuff results in air leak with all the disadvantages of an unsealed tracheal airway; namely, an absent endtidal CO 2 signal in spite of correct tracheal intubation, imprecise endtidal‐CO 2 monitoring, impaired ventilation and oxygenation, environmental pollution with anesthetic gases with increased gas consumption and ultimately the risk of tube exchange, as is known from uncuffed tracheal tubes . The use of higher cuff pressures carries the risk of ischemic damage to the tracheal mucosa and cannot be recommended .…”

Section: Discussionmentioning

confidence: 99%

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

Fischer

Grass

Kemper

et al. 2020

Pediatric Anesthesia

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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

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Section: Discussionmentioning

confidence: 99%

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

Fischer

Grass

Kemper

et al. 2020

Pediatric Anesthesia

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“…The methods of tracheal measurement have included cadaver measurement, chest radiograph, ultrasound, magnetic resonance imaging (MRI), and CT scan . However, most of the measurement data are based on Western literature, with very few Asian studies . In children, it is imperative that ethnic communities have their own data for the normative values for tracheal dimensions.…”

Section: Discussionmentioning

confidence: 99%

Pediatric tracheal dimensions on computed tomography and its correlation with tracheostomy tube sizes

et al. 2019

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Objective: Age-based formulas for selecting the appropriate size of tracheostomy tubes in children are based on data on tracheal dimensions. This study aims to measure the tracheal dimensions of Indian children by computerized tomography (CT) and to compare this with the dimensions of age-appropriate tracheostomy tubes.Methods: CT scans of children aged less than 16 years that were taken for indications other than respiratory distress were included. Tracheal diameters at the tracheostomy point and tracheal length from the tracheostomy point to the carina were calculated from the scans. These dimensions were correlated with age, weight, and height. The measurement on the CT scan was used to predict the appropriate size of tracheostomy tube, which was compared with the tracheostomy tube sizes.Results: Two hundred and fourteen CT scans of children aged below 16 years were included in the study. On multiple logistic regression analysis, tracheal diameter correlated well with age and weight (P = 0.04 and 0.001, respectively), whereas tracheal length correlated well with age and height of the child (P = 0.03 and 0 < 0.001, respectively).On comparison with dimensions of the tracheostomy tube, tracheal diameter correlated well, and the length was found to be longer than needed to prevent endobronchial intubation. The regression value was used to predict the size of an ideal tracheostomy tube.Conclusion: Tracheal diameter of Indian children correlates well with the outer diameter of age-appropriate tracheostomy tubes, but the length of these tubes is longer than the ideal length. This would necessitate a change in the design of these tubes.

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“…If there is to be new data, the template of large national databases which are related, used by Strøm et al should be considered, but with agreed standardised principles, questions and definitions that allow for meaningful comparison and detection of rare, but clinically important events. Kurth et al have shown how quality improvement can produce results, by delivering the effective therapies that already exist , and the anaesthetic literature contains many examples of possible candidate interventions .…”

Section: Discussionmentioning

confidence: 99%

Taking stock of anaesthetic databases: enough data, time for action!

Cunnington

2018

Anaesthesia

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For almost 60 years, the paediatric anaesthetic literature has witnessed multiple publications reviewing epidemiological data with regard to anaesthetic practice, including morbidity, mortality and risk. This edition of Anaesthesia contains the most recent of these, from Strøm et al. looking at the characteristics of those under two years of age undergoing anaesthesia [1]. However, after six decades where extraordinary improvements in information technology with regard to databases, processing data and the worldwide sharing of information have occurred, should we not be expecting more from such epidemiological surveys than just reaffirming what we already know, and should we be demanding more from our electronic information systems? Literature reviewThe earliest of these publications were retrospective studies that produced estimates of risk, but no assessment of risk factors [2][3][4][5]. The next 30 years saw the publication of five epidemiological studies [6-10], which Patterson and Waterhouse noted that, despite significant differences in the design of these studies, could be considered as a group because the risk profiles produced were nearly identical, (infants are at greater risk of complications, ASA physical status 3 or greater increases risk substantially) [11]. These studies are summarised in Table 1. Tiret et al. published the first prospective multicentre study quoting an anaesthetic mortality of 1:40,000, and with a significantly higher risk of incidents in infants than in children (1:250 vs. 1:2000, p < 0.001) which increased significantly with higher ASA physical status [6]. Tay et al. not only replicated these findings but also highlighted that respiratory events were the most frequent (77.4%), with laryngospasm accounting for 35.7% [7], while Murat et al. recorded an incidence of respiratory events of 53% [8]. Both acknowledged that their results were potentially affected by the underreporting that is endemic within a voluntary system. The first study investigating cardiac arrest in children (paediatric peri-operative cardiac arrest (POCA) registry) was published at the beginning of the millennium by Morray et al.; quoting a rate of 1.4:10,000 anaesthetics; over half of these occurred in infants and two-thirds occurred in ASA physical status 3 to 4 patients (accounting for 95% of deaths) [9]. Data for the following six years of the POCA registry were published in 2007 by Bhananker et al. and the main difference was a reduction in medication-related arrests, attributed predominantly to a reduction in halothane-induced cardiac arrest [10].Differences in the design of these studies and definitions of incidents might account for discrepancies between studies, and paradoxically, as practice becomes safer, the harder it becomes to demonstrate further improvements, particularly at any one institution [12]. Although beset with problems of under-reporting and how incidents were defined, the analysis of critical incidents can help to determine what improvements might be made. An analysis of critical incid...

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Cuffed versus uncuffed endotracheal tubes for general anaesthesia in children aged eight years and under

Cited by 20 publications

References 31 publications

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

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

Pediatric tracheal dimensions on computed tomography and its correlation with tracheostomy tube sizes

Taking stock of anaesthetic databases: enough data, time for action!

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