The use of cuffed tracheal tubes for paediatric tracheal intubation, a survey of specialist practice in the United Kingdom

Abstract

Cuffed tracheal tubes are rarely routinely used in children, particularly in the under 8 yr age group, in specialist paediatric centres in the UK. When used, it is predominantly for a specific indication, and the monitoring of intracuff pressure is not routine. Current expert consensus is that complications are equally as common when using a cuffed as an uncuffed tube.

Use of cuffed tracheal tubes in neonates, infants and children: A practice survey of members of the Society of Pediatric Anesthesia

“…This substantively exceeds the results from two previous surveys in which 25% of respondents in France in 2001 [5] and 7% in the UK in 2008 [6] used CTT in children b 8 years of age. If we assume that global trends in pediatric anesthesia are homogeneous, these results suggest a paradigm shift towards the use of CTT in children.…”

Cuffed endotracheal tubes in paediatrics

“…3 The past decade has witnessed a growing body of evidence in support of high-volume, low-pressure CETTs in paediatric airway management. 2 Studies have confirmed that they are not associated with an increased risk of post-extubation stridor or the need for tracheostomy in general paediatric critical care units. 3 Smaller-sized CETTs reduce the pressure that is exerted by the tube shaft on the susceptible, nondistensible cricoid and seal the airway within the less susceptible, more elastic trachea by means of a cuff with monitored cuff pressure.…”

“…There were also concerns that ill-fitting or poorly designed CETTs could cause tissue damage to the larynx and airway mucosa, resulting in subglottic stenosis. [2][3][4][5] A UETT was thought to seal adequately as it passed through the cricoid ring. This was fuelled by well-founded fears of tracheal injury from the high-pressure, low-volume cuffs that were in common use years ago and the fact that cuffed tubes in very small sizes were not available.…”

“…Two recent in vivo studies, one using magnetic resonance imaging in sedated children, and the other videobronchoscopy in paralysed children, have revealed that the cricoid area is ellipsoid with a smaller transverse diameter, and is not circular in shape, as previously thought. 2,11,12 This means that a tight-fitting UETT or even an optimally fitted tube in young children with acceptable pressure leak, i.e. 20 cmH 2 O, would exert more compression, if not ischaemia, on the transverse mucosa of the cricoid ring.…”

The effect of pilot balloon design on estimation of safe tracheal tube cuff pressure

“…A subsequent Intensive Care Society guideline [11] recommends that tracheostomy cuff pressure should be checked regularly with a manometer and kept below 25 cmH 2 O. It is not standard practice to check tracheal tube cuff pressures routinely during anaesthesia [12] despite several studies concluding that this is best practice [13][14][15]. Evaluation of cuff pressures using clinical endpoints, such as palpation or air leak, has been shown to be inaccurate in patients in theatre [14,15], intensive care [10,16,17], and the emergency department [18].…”