Cuffed ETT outperforms Uncuffed ETT for pediatric patients
“Cuffed vs. uncuffed tracheal tubes in children: a randomised controlled trial comparing leak, tidal volume and complications”
The Bottom Line: Cuffed endotracheal tubes (ETT) leak less and provide greater tidal volumes when compared to uncuffed endotracheal tubes for routine elective surgery in the pediatric population. In addition, this study showed that patients who got uncuffed tubes had more short term complications than those with cuffed tubes and neither group had any long term complications at up to 5 year follow up.
This study was done in the OR and not the ED and focuses on the function of the cuffed ETT vs. uncuffed ETT. It also shows few short term adverse events in both groups however, there were statistically significantly fewer in the cuffed ETT group. The study adds to the body of evidence supporting the trend of using cuffed ETT in pediatric patients.
Background: Uncuffed endotracheal tubes have traditionally been used for pediatric intubations. This is primarily due to the differences in anatomy of the pediatric subglottic anatomy and the potential impact of using of a cuffed tracheal tube in this population. The concern is that because the pediatric trachea narrows to the level of the cricoid, balloon inflation in this area could lead to short term mucosal damage, edema, and laryngospasm as well as trachea stenosis in the long term.
The Study: This is a single center, randomized parallel group study that took place in Australia from February 2012 to January 2014. 104 children aged 0-16 years old were randomized on a 1:1 basis to receive either uncuffed or cuffed ETT for airway management during elective surgery. Initial tube sizes were determined by formula and adjusted as needed. Vent settings were standardized. Inspiratory and expiratory tidal volumes were recorded in volume controlled ventilation, pressure controlled ventilation at different levels of PEEP and several times after performing a standardized recruitment maneuver. Leak volume was calculated from these measurements. Patients were observed for adverse events immediately after the procedure and followed from 3 to 5 years to look for long term complications.
Results: There were 104 patients split evenly among the cuffed ETT vs. uncuffed ETT groups. Data for 18 patients from the uncuffed group had to be excluded due to tube related problems (i.e. leak around tube was too large). Data from all those in the cuffed group was used. 80% of the tubes in the cuffed group were sized correctly on the first intubation attempt as opposed to only 30% in the uncuffed group. Leakage around the tube was significantly smaller in the cuffed group at every measurement point. Incidence of complications was low in both groups, however perioperative adverse events and follow up complications were statistically significantly less in the cuffed group.