• Anaesthesia · Sep 2019

    Comment

    Cuffed tracheal tubes: guilty now proven innocent.

    Why should I read this?

    The cuffed vs non-cuffed ETT debate for children and neonates is largely settled, demonstrating the superiority of modern cuffed tubes over their historical, uncuffed forbears. Nevertheless, despite reliable evidence to the contrary, many general anaesthetists still prefer uncuffed tubes for children.

    Give me the quick overview

    Shah & Carlisle explore the accumulated evidence supporting the shift to cuffed endotracheal tubes by paediatric anaesthetists, both in neonates and older children.

    They challenge historical airway anatomy & physiology myths that once encouraged the use of uncuffed ETTs in children, and the questionable reliability of the widely-used Cole formula for tube size prediction (size = age/4 + 4; correct in only 50-75%).

    The development of Weiss et al.'s Microcuff™ tube represents a watershed moment in addressing concerns of paediatric airway trauma from cuffed ETTs, resulting in improved ETT function without any increase in stridor.

    More recently, Chamber's 2018 RCT compared cuffed and uncuffed ETTs in children undergoing elective general anaesthesia, and found that cuffed tubes improved ventilation and reduced short-term post-operative respiratory complications, in addition to decreasing tube changes.

    Addressing concern for increased work-of-breathing and higher inspiratory pressures when using a 0.5 mm smaller ID tube, Shah & Carlisle note Thomas et al.'s 2018 laboratory study showing any such effect is easily compensated for with pressure support and automatic tube compensation.

    Similarly, the authors also note that there has been no demonstrated evidence of an increased incidence of subglottic stenosis in children using cuffed ETTs.

    Finally, Shah & Carlisle report on their updated meta-analysis, showing that cuffed tracheal tubes in children result in fewer tube changes and less sore throat, but no difference in risk of laryngospasm.

    Finally word

    Using a modern, Microcuff™ or equivalent cuffed ETT that is 0.5 mm smaller in size than an equivalent uncuffed tube, offers functional, ventilation and safety benefits.

    summary
    • A Shah and J B Carlisle.
    • Nuffield Department of Anaesthesia, John Radcliffe Hospital, Oxford, UK.
    • Anaesthesia. 2019 Sep 1; 74 (9): 1186-1190.

    no abstract available

      Pubmed     Full text   Copy Citation  

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

    Notes

    summary
    1

    Why should I read this?

    The cuffed vs non-cuffed ETT debate for children and neonates is largely settled, demonstrating the superiority of modern cuffed tubes over their historical, uncuffed forbears. Nevertheless, despite reliable evidence to the contrary, many general anaesthetists still prefer uncuffed tubes for children.

    Give me the quick overview

    Shah & Carlisle explore the accumulated evidence supporting the shift to cuffed endotracheal tubes by paediatric anaesthetists, both in neonates and older children.

    They challenge historical airway anatomy & physiology myths that once encouraged the use of uncuffed ETTs in children, and the questionable reliability of the widely-used Cole formula for tube size prediction (size = age/4 + 4; correct in only 50-75%).

    The development of Weiss et al.'s Microcuff™ tube represents a watershed moment in addressing concerns of paediatric airway trauma from cuffed ETTs, resulting in improved ETT function without any increase in stridor.

    More recently, Chamber's 2018 RCT compared cuffed and uncuffed ETTs in children undergoing elective general anaesthesia, and found that cuffed tubes improved ventilation and reduced short-term post-operative respiratory complications, in addition to decreasing tube changes.

    Addressing concern for increased work-of-breathing and higher inspiratory pressures when using a 0.5 mm smaller ID tube, Shah & Carlisle note Thomas et al.'s 2018 laboratory study showing any such effect is easily compensated for with pressure support and automatic tube compensation.

    Similarly, the authors also note that there has been no demonstrated evidence of an increased incidence of subglottic stenosis in children using cuffed ETTs.

    Finally, Shah & Carlisle report on their updated meta-analysis, showing that cuffed tracheal tubes in children result in fewer tube changes and less sore throat, but no difference in risk of laryngospasm.

    Finally word

    Using a modern, Microcuff™ or equivalent cuffed ETT that is 0.5 mm smaller in size than an equivalent uncuffed tube, offers functional, ventilation and safety benefits.

    Daniel Jolley  Daniel Jolley
     
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