Prospective randomized controlled multi-centre trial of cuffed or uncuffed endotracheal tubes in small children
M Weiss, A Dullenkopf, J E Fischer, C Keller, A C Gerber, European Paediatric Endotracheal Intubation Study Group, M Bernath, C Best, S Bew, J Bihlmayer, M Bloch, V Boels, P Bolton, K Boos, P Brooks, J Brown, D Crass, D Csomor, M Dolci, T Engelhardt, S Eschertzhuber, H Forst, B Frank, A Frotzler, O Gabriel, L Gajdosiva, S Galton, F Gerheuser, J Giest, R Greif, M Grochova, W Habre, M Hadrawa, B Hartmann, W Heindl, G Henze, O Hilfiker, S Hivey, C Hoehne, H Hollnberger, T Hüttl, B Kalnasova, T Kirwan, B Komanova, J Korcek, S Krohn, M Kulkarni, P A Lonnqvist, A Machotta, G Meakin, V Mixa, N Morton, T Nicolai, M Oberhauser, M Pellegrini, T Pirotte, B Podhoransky, H J Rapp, M Rolfs, W Roth, B Salgo, H Schepperle, J Schimpf, A Schmitz, V Sollmann, St Seiler, J Strauss, F Stucki, E Thil, F Veyckemans, L Wichert, A Willker, G Wilson, M Weiss, A Dullenkopf, J E Fischer, C Keller, A C Gerber, European Paediatric Endotracheal Intubation Study Group, M Bernath, C Best, S Bew, J Bihlmayer, M Bloch, V Boels, P Bolton, K Boos, P Brooks, J Brown, D Crass, D Csomor, M Dolci, T Engelhardt, S Eschertzhuber, H Forst, B Frank, A Frotzler, O Gabriel, L Gajdosiva, S Galton, F Gerheuser, J Giest, R Greif, M Grochova, W Habre, M Hadrawa, B Hartmann, W Heindl, G Henze, O Hilfiker, S Hivey, C Hoehne, H Hollnberger, T Hüttl, B Kalnasova, T Kirwan, B Komanova, J Korcek, S Krohn, M Kulkarni, P A Lonnqvist, A Machotta, G Meakin, V Mixa, N Morton, T Nicolai, M Oberhauser, M Pellegrini, T Pirotte, B Podhoransky, H J Rapp, M Rolfs, W Roth, B Salgo, H Schepperle, J Schimpf, A Schmitz, V Sollmann, St Seiler, J Strauss, F Stucki, E Thil, F Veyckemans, L Wichert, A Willker, G Wilson
Abstract
Background: The use of cuffed tracheal tubes (TTs) in small children is still controversial. The aim of this study was to compare post-extubation morbidity and TT exchange rates when using cuffed vs uncuffed tubes in small children.
Methods: Patients aged from birth to 5 yr requiring general anaesthesia with TT intubation were included in 24 European paediatric anaesthesia centres. Patients were prospectively randomized into a cuffed TT group (Microcuff PET) and an uncuffed TT group (Mallinckrodt, Portex, Rüsch, Sheridan). Endpoints were incidence of post-extubation stridor and the number of TT exchanges to find an appropriate-sized tube. For cuffed TTs, minimal cuff pressure required to seal the airway was noted; maximal cuff pressure was limited at 20 cm H(2)O with a pressure release valve. Data are mean (SD).
Results: A total of 2246 children were studied (1119/1127 cuffed/uncuffed). The age was 1.93 (1.48) yr in the cuffed and 1.87 (1.45) yr in the uncuffed groups. Post-extubation stridor was noted in 4.4% of patients with cuffed and in 4.7% with uncuffed TTs (P=0.543). TT exchange rate was 2.1% in the cuffed and 30.8% in the uncuffed groups (P<0.0001). Minimal cuff pressure required to seal the trachea was 10.6 (4.3) cm H(2)O.
Conclusions: The use of cuffed TTs in small children provides a reliably sealed airway at cuff pressures of <or=20 cm H(2)O, reduces the need for TT exchanges, and does not increase the risk for post-extubation stridor compared with uncuffed TTs.
Source: PubMed