Laryngeal damage due to an unexpectedly large and inappropriately designed cuffed pediatric tracheal tube in a 13-month-old child

Intubation depth markings allow an improved positioning of endotracheal tubes in children

“…5,28 Thus, it is not surprising that laryngeal lesions have been reported with cuffed tracheal tubes in children and adults. [29][30][31] Consequently, a laryngeal cuff-free portion of the tube is mandatory for safe placement of cuffed tracheal tubes in children. 32 This is best achieved with intubation depth marks, since these guarantee a constant cuff-free distance between the vocal cords and upper border of the cuff.…”

Should cuffed endotracheal tubes be used routinely in children?

“…Ho et al have pointed out that with some endotracheal tubes, when the cuff is located immediately below the vocal cords, the tube tip may already be at the carina. 9 Dillier et al recently reported laryngeal damage from an inappropriately designed cuffed tube in a 13-month-old child, 10 although the use of an unsuitably large size of tube may have contributed to the damage in this case.…”

“…Although they are probably safe in most instances, there are isolated reports of complications related to the cuff. 10 Cuffed tube designs are not ideal, but there are promising advances being made in this area. 1 For the majority of children under eight years of age, uncuffed tubes are still a reasonable choice, although there are specific situations where a cuffed tube may be of particular value.…”

“…9 Dillier et coll. ont récemment rapporté des lésions du larynx causées par un tube à ballonnet qui ne convenait pas à un enfant de 13 mois, 10 même si l'usage d'un tube de trop grande taille peut avoir contribuer à la lésion dans ce cas.…”

Internal or external diameter?

“…To the Editor: We read with interest the report by Dillier et al 1 on a case of laryngeal damage in an infant caused by a too large and inappropriately designed cuffed tracheal tube.…”