Tube Exchanges and Respiratory Adverse Events in Infants up to 3 Months of Age Using Microcuff and Uncuffed Endotracheal Tubes: A Randomized Study
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Abstract
Background: Optimal sizing of endotracheal tubes (ETTs) in pediatric patients may lead to repeated laryngoscopies, intubations, and ETT exchanges. The subglottis is functionally the narrowest part of the pediatric airway and is prone to edema, tracheal lumen narrowing, and post-extubation stridor due to repeated airway manipulations. Objectives: To compare the proportion of infants up to 3 months of age who require ETT exchanges and who develop postoperative respiratory adverse events (PRAEs) following intubation with Microcuff versus uncuffed ETTs.
Methods: This prospective randomized study included 100 patients up to 3 months of age. They were randomized into two groups of 50 each: Gp M: intubated with microcuff ETT. Gp U: intubated with uncuffed ETT. A leak test was done after intubation. In Gp U, excessive leak at 10 cm of water pressure required a 0.5-size bigger ETT. A minimal leak at 10-20 cm of water was acceptable. No leak at 20 cm of water required downsizing ETT by 0.5. In Gp M, the cuff was inflated until minimal leak at 10-20 cm of water. No leak with the deflated cuff at 20 cm of water warranted exchange with an uncuffed ETT of size 3.0.
Results: In Gp U, 12/50 (24%) patients underwent tube exchanges, and 6/50 (12%) had post-extubation stridor. In group M, 4/50 (8%) patients required tube exchange to size 3.0 uncuffed ETT, and one patient (2%) had post-extubation stridor.
Conclusion: Microcuff ETTs have a lesser incidence of tube exchange and post-extubation stridor as compared to uncuffed ETTs in infants up to three months of age.
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| Issue | Article in Press |
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| Section | Research Article(s) | |
| Keywords | ||
| Airway management Infant Intubation Newborn Patient safety Stridor | ||
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