Pediatric cuffed endotracheal tubes

Abstract

Endotracheal intubation in children is usually performed utilizing uncuffed endotracheal tubes for conduct of anesthesia as well as for prolonged ventilation in critical care units. However, uncuffed tubes may require multiple changes to avoid excessive air leak, with subsequent environmental pollution making the technique uneconomical. In addition, monitoring of ventilatory parameters, exhaled volumes, and end-expiratory gases may be unreliable. All these problems can be avoided by use of cuffed endotracheal tubes. Besides, cuffed endotracheal tubes may be of advantage in special situations like laparoscopic surgery and in surgical conditions at risk of aspiration. Magnetic resonance imaging (MRI) scans in children have found the narrowest portion of larynx at rima glottides. Cuffed endotracheal tubes, therefore, will form a complete seal with low cuff pressure of <15 cm H2O without any increase in airway complications. Till recently, the use of cuffed endotracheal tubes was limited by variations in the tube design marketed by different manufacturers. The introduction of a new cuffed endotracheal tube in the market with improved tracheal sealing characteristics may encourage increased safe use of these tubes in clinical practice. A literature search using search words "cuffed endotracheal tube" and "children" from 1980 to January 2012 in PUBMED was conducted. Based on the search, the advantages and potential benefits of cuffed ETT are reviewed in this article.

Tubos endotraqueales con cuff en anestesia pediátrica: ¿aumentan el riesgo de estridor post-extubación? Estudio observacional, cohorte prospectiva

“…No sabemos la manera como fue elegido el tamaño del tubo con cuff en los pacientes de este estudio, ni si se utilizó alguna de las fórmula disponibles, (Motoyoma, Khine) 7 , esta elección simplemente se dejó a criterio del anestesiólogo tratante puesto que se trató de un estudio observacional.…”

“…El uso de cuff ofrece múltiples ventajas 7 como un mejor sello y protección de la vía aérea, menor necesidad de cambios de tubos, disminución de la contaminación ambiental por gases anestési-cos, medición más exacta del CO 2 espirado y de los parámetros ventilatorios. Estos beneficios han impulsado la utilización de tubos con cuff en anestesia pediátrica 7 , sin aumentar los efectos adversos, lo que ha sido demostrado en 2 estudios que aportan evidencia de primera categoría 8,9 . Recientemente con el advenimiento de nuevas técnicas diagnósticas 10,11 , se ha cuestionado el paradigma clásico, debido a que las imágenes obtenidas en niños sedados y en ventilación espontánea ubican el punto más estrecho de la laringe en la abertura glótica, sin mayores cambios durante el desarrollo posterior 10 .…”

“…The cuffed tracheal tubes effect on stridor risk, (adjusting for confounders), was non-significant: OR = 2,2; Conf. Interval 95% [0, [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]; p = 0,5. Conclusions: The use of cuffed endotracheal tubes did not increase the risk of post-extubation stridor in children.…”

Oral endotracheal intubation in pediatric anesthesia

“…Traditionally, it has been thought that the pediatric larynx is funnel-shaped, with the narrowest portion being situated at the cricoid cartilage, and then becomes more cylindrical as the child grows with the narrowest portion occurring at the vocal cords [5]. Based on this traditional anatomical concept of the pediatric airway, it has generally been accepted that uncuffed ETTs should be used for children younger than 8 years.…”

“…However, in cases without air leakage, we should first check for the presence of laryngospasm, which can be resolved by deep anesthesia, before changing ETT size [2]. If there is excessive air leakage, the ventilatory parameters, exhaled volumes, and end-expiratory gases are unreliable during intraoperative monitoring, and the ETT should be replaced with one that has an ID 0.5 mm greater [2,5]. Thus, uncuffed ETTs may require more laryngoscopies to change the tube.…”