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

Abstract

Implications for practiceWe are unable to draw definitive conclusions about the comparative effects of cuffed or non-cuffed endotracheal tubes in children undergoing general anaesthesia. Our confidence is limited by risks of bias, imprecision and indirectness. The lower requirement for exchange of tubes with cuffed ETTs was very low-quality evidence, and the requirement for less medical gas used and consequent lower cost was low-quality evidence. In some cases, tracheal re-intubation is required to guarantee an open airway when adequate oxygenation is difficult after removal of the tube, for a variety of reasons including stridor, muscle weakness or obstruction. No data were available to permit evaluation of whether appropriate tidal volumes were delivered. Implications for researchLarge randomized controlled trials of high methodological quality should be conducted to help clarify the risks and benefits of cuffed ETTs for children. Such trials should investigate the capacity to deliver appropriate tidal volume. Future trials should also address cost effectiveness and respiratory complications. Such studies should correlate the age of the child with the duration of intubation, and with possible complications. Studies should also be conducted in newborn babies. Future research should be conducted to compare the effects of the different types or brands of cuffed tubes used worldwide. Finally, trials should be designed to perform more accurate assessments and to diagnose the complications encountered with cuffed compared to uncuffed ETTs.

The incidence of postoperative respiratory complications: A retrospective analysis of cuffed vs uncuffed tracheal tubes in children 0‐7 years of age

“…The authors of a Cochrane systematic review of cuffed vs uncuffed endotracheal tubes for general anesthesia in children aged 8 years and under could not draw a definitive conclusion about the comparative effects of cuffed or uncuffed endotracheal tubes in children undergoing general anesthesia . The largest randomized controlled, multicenter trial also did not show a significant difference in the occurrence of acute postoperative respiratory complications .…”

“…children undergoing general anesthesia. 22 The largest randomized controlled, multicenter trial also did not show a significant difference in the occurrence of acute postoperative respiratory complications. 9 In this study, the tracheae of children between birth and 5 years of age were intubated with either an uncuffed or a special pediatric Previous prospective observational studies (n = 243 and 597 patients) conducted in PACUs that used standard design cuffs did | 215 not show any significant difference between the safety of cuffed and uncuffed tubes.…”

Time to stop using uncuffed tracheal tubes in children?

“…The results of a Cochrane review comparing cuffed with uncuffed tracheal tubes are due to be released soon and I await the findings with great interest, but in the meantime, I aim to convince you that cuffed, rather than uncuffed, tracheal tubes should be the preferred choice for children other than neonates.…”

Oral endotracheal intubation in pediatric anesthesia

“…While the Pediatric Advanced Life Support guidelines of the American Heart Association recommend the use of cuffed ET tubes as an alternative to uncuffed ET tubes [11], the risks and benefits of cuffed versus uncuffed ETTs in children are still controversial, mainly because of the low quality of existing evidence [12]. Well-designed randomized controlled trials with robust qualitative methodologies should be conducted to shed further light on this subject.…”