• Anaesthesia · Feb 2018

    Randomized Controlled Trial

    Cuffed vs. uncuffed tracheal tubes in children: a randomised controlled trial comparing leak, tidal volume and complications.

    Cuffed paediatric endotracheal tubes improve ventilation and reduce peri-operative respiratory complications in children undergoing elective general anaesthesia.

    pearl
    • N A Chambers, A Ramgolam, D Sommerfield, G Zhang, T Ledowski, M Thurm, M Lethbridge, M Hegarty, and B S von Ungern-Sternberg.
    • Department of Anaesthesia, Princess Margaret Hospital for Children, Perth, Australia.
    • Anaesthesia. 2018 Feb 1; 73 (2): 160-168.

    AbstractCuffed tracheal tubes are increasingly used in paediatric anaesthetic practice. This study compared tidal volume and leakage around cuffed and uncuffed tracheal tubes in children who required standardised mechanical ventilation of their lungs in the operating theatre. Children (0-16 years) undergoing elective surgery requiring tracheal intubation were randomly assigned to receive either a cuffed or an uncuffed tracheal tube. Assessments were made at five different time-points: during volume-controlled ventilation 6 ml.kg-1 , PEEP 5 cmH2 O and during pressure-controlled ventilation 10 cmH2 O / PEEP 5 cmH2 O. The pressure-controlled ventilation measurement time-points were: just before a standardised recruitment manoeuvre; just after recruitment manoeuvre; 10 min; and 30 min after the recruitment manoeuvre. Problems and complications were recorded. During volume-controlled ventilation, leakage was significantly less with cuffed tracheal tubes than with uncuffed tracheal tubes; in ml.kg-1 , median (IQR [range]) 0.20 (0.13-0.39 [0.04-0.60]) vs. 0.82 (0.58-1.38 [0.24-4.85]), respectively, p < 0.001. With pressure-controlled ventilation, leakage was less with cuffed tracheal tubes and stayed unchanged over a 30-min period, whereas with uncuffed tracheal tubes, leakage was higher and increased further over the 30-min period. Tidal volumes were higher in the cuffed group and increased over time, but in the uncuffed group were lower and decreased over time. Both groups showed an increase in tidal volumes following recruitment manoeuvres. There were more short-term complications with uncuffed tracheal tubes, but no major complications were recorded in either group at long-term follow-up. With standardised ventilator settings, cuffed tracheal tubes produced better ventilation characteristics compared with uncuffed tracheal tubes during general anaesthesia for routine elective surgery.© 2017 The Association of Anaesthetists of Great Britain and Ireland.

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    This article appears in the collection: Use of cuffed endotracheal tubes in pediatric anesthesia.

    Notes

    pearl
    1

    Cuffed paediatric endotracheal tubes improve ventilation and reduce peri-operative respiratory complications in children undergoing elective general anaesthesia.

    Daniel Jolley  Daniel Jolley
    summary
    1

    What did they do?

    Chambers et al. compared ventilation parameters and respiratory complications in 104 children randomly allocated to ventilation with either a cuffed or non-cuffed ETT. They primarily investigated airway leak as measured by the difference between inspiratory and expiratory volumes.

    And they found?

    For both volume and pressure-controlled ventilation, leakage was lower for cuffed tubes than uncuffed. Notably leak was stable with cuffed tubes and PCV, but progressively increased over 30 minutes after intubation with an uncuffed tube.

    Cuffed tubes required fewer intubations and changes, and resulted in fewer short-term complications (coughing, desaturation, hoarseness or sore throat).

    Take-home message

    Modern cuffed paediatric endotracheal tubes offer significant clinical advantages over uncuffed ETTs.

    Daniel Jolley  Daniel Jolley
     
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