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

Published online by Cambridge University Press:  01 August 2008

P. E. Flynn ,
A. E. Black  and
V. Mitchell
P. E. Flynn*
Affiliation:
Royal Marsden Hospital, Department of Anaesthesia, London, UK
A. E. Black
Affiliation:
Great Ormond Street Hospital for Children, Department of Anaesthesia, London, UK
V. Mitchell
Affiliation:
University College Hospital, Department of Anaesthesia, London, UK
*
Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK. E-mail: [email protected]; Tel: +44 20 7808 2727; Fax: +44 20 7352 975
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Summary

Background and objective

For more than 50 yr, uncuffed tracheal tubes have been the gold standard for intubation in children under the age of 8 yr. However, recently there has been interest in the use of cuffed tubes in paediatric practice. This survey aimed to benchmark UK practice with regard to tracheal intubation within specialist paediatric centres, exploring current cuffed tracheal tube use in children.

Methods

A questionnaire was e-mailed to the paediatric intensive care unit and anaesthetic department clinical leads in all UK specialist paediatric hospitals with a paediatric intensive care unit (n = 30). Information was requested on the use of tracheal tubes across all paediatric age groups, as well as the reasons for non-use and the incidence of complications attributed to cuffed tubes.

Results

A total of 20 paediatric intensive care unit and 15 anaesthetic questionnaires were returned, equating to a response rate of 67% and 50%, respectively. Only 5% of the paediatric intensive care unit and 7% of the anaesthetic respondents routinely use a cuffed tube in children under the age of 8 yr. The commonest reason cited in both groups for non-cuff use was that there is minimal benefit to be gained over using an uncuffed tracheal tube. The most frequent specific indication for use of a cuffed tube was a reduced lung compliance (60% respondents both groups). In all, 45% of the paediatric intensive care unit respondents and 100% of the anaesthetists reported that they did not routinely monitor the intracuff pressure when using a cuffed tube. The incidence of observed complications attributed to the use of cuffed tubes was far higher amongst paediatric intensive care unit consultants (65% vs. 7% anaesthetists); however, the majority in both groups stated that such complications were no more common than when using an uncuffed tube (60% paediatric intensive care unit and 53% anaesthetists).

Conclusion

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.

Keywords

INTUBATION INTRATRACHEALCHILDCHILD PRESCHOOLINFANTEQUIPMENT DESIGN, tube cuffs
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 8 , August 2008 , pp. 685 - 688
Copyright
Copyright © European Society of Anaesthesiology 2008

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References

1.Eckenhoff, JE. Some anatomic considerations of the infant larynx influencing endotracheal anesthesia. Anesthesiology 1951; 12 (4): 401–410.CrossRefGoogle ScholarPubMed
2.Khine, HH, Corddry, DH, Kettrick, RG et al. Comparison of cuffed and uncuffed endotracheal tubes in young children during general anesthesia. Anesthesiology 1997; 86 (3): 627–631.CrossRefGoogle ScholarPubMed
3.Deakers, TW, Reynolds, G, Stretton, M, Newth, CJ. Cuffed endotracheal tubes in pediatric intensive care. J Pediatr 1994; 125 (1): 57–62.CrossRefGoogle ScholarPubMed
4.Newth, CJ, Rachman, B, Patel, N, Hammer, RG. The use of cuffed versus uncuffed endotracheal tubes in pediatric intensive care. J Pediatr 2004; 144: 333–337.CrossRefGoogle ScholarPubMed
5.Dullenkopf, A, Schmitz, A, Gerber, A, Weiss, M. Tracheal sealing characteristics of pediatric cuffed tracheal tubes. Paediatr Anesth 2004; 14: 825–830.CrossRefGoogle ScholarPubMed
6.Orliaquet, G, Renaud, E, Lejay, M et al. Postal survey of cuffed or uncuffed tracheal tubes used for paediatric tracheal intubation. Paediatr Anesth 2001; 11: 277–281.CrossRefGoogle Scholar
7.Dillier, CM, Trachsel, D, Baulig, W, Gysin, C, Gerber, AC, Weiss, M. Laryngeal damage due to an unexpectedly large and inappropriately designed cuffed pediatric tracheal tube in a 13-month-old child. Can J Anesth 2004; 51 (1): 72–75.CrossRefGoogle Scholar
8.Weiss, M, Dullenkopf, A, Gysin, C, Dillier, CM, Gerber, AC. Shortcomings of cuffed paediatric tracheal tubes. Br J Anaesth 2004; 92: 78–88.CrossRefGoogle ScholarPubMed
9.Holzki, J. Laryngeal damage from tracheal intubation. Paediatr Anaesth 1997; 7: 435–437.CrossRefGoogle ScholarPubMed
10.Litman, RS, Weissend, EE, Shibata, D, Westesson, P-L. Developmental changes of laryngeal dimensions in unparalysed, sedated children. Anesthesiology 2003; 98: 41–45.CrossRefGoogle Scholar
11.James, I. Cuffed tubes in children. Paediatr Anaesth 2001; 11: 259–263.CrossRefGoogle ScholarPubMed
12.Bernet, V, Dullenkopf, A, Maino, P, Weiss, M. Outer diameter and shape of paediatric tracheal tube cuffs at higher inflation pressures. Anaesthesia 2005; 60 (11): 1123–1128.CrossRefGoogle ScholarPubMed
13.Spittle, CSN, Beavis, SE. Do you measure tracheal cuff pressure? A survey of clinical practice. Br J Anaesth 2001; 87 (2): 344P–345P.Google Scholar