Cuffed vs. Uncuffed Tracheal Tubes for Children: Time to Let Go of Old Dogma
Daniel M. Lindberg, MD
In a randomized trial, cuffed tubes had better tidal volumes and less leakage.
Dogma suggests using uncuffed endotracheal tubes for children
These authors compared leakage, ventilation, and complications with cuffed versus uncuffed endotracheal tubes in a randomized trial of 104 children aged ≤16 years undergoing elective surgery at a single pediatric center in Australia. Initial tube size was 0.5-mm smaller for cuffed than uncuffed tubes. Cuff pressure was set to ≤20 cm H2O and monitored continuously. Participants were followed for 3 to 5 years for long-term outcomes.
Of children randomized to uncuffed tubes, 34% had limited data because airway leak was too large, or they required switching to a cuffed tube. During the first intubation attempt, a correctly sized tube was successfully placed in 80% of patients randomized to cuffed tubes, compared with only 30% of patients randomized to uncuffed tubes. Airway leakage (the primary endpoint) was significantly higher with uncuffed tubes (median, 0.92 vs. 0.20 mL/kg) and expiratory tidal volume was lower (median, 5.48 vs. 6.10 mL/kg). Findings were similar in the subgroup of patients
These findings add to mounting evidence rejecting the old dogma about use of cuffed tubes in children. An editorialist notes that practice has been changing, with pediatric anesthesiologists now preferring cuffed tubes. Use cuffed tubes for all children except neonates, and remember to check cuff pressure.
Chambers NA et al. Cuffed vs. uncuffed tracheal tubes in children: A randomised controlled trial comparing leak, tidal volume and complications. Anaesthesia 2017 Nov 23; [e-pub].
Bailey CR.Time to stop using uncuffed tracheal tubes in children? Anaesthesia 2017 Nov 23; [e-pub].
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