The use of cuffed versus uncuffed endotracheal tubes in pediatric intensive care.
OBJECTIVE
To report our experience with cuffed endotracheal tubes (ETT) in a large cohort of critically ill children. Study design We prospectively collected data over a 1-year period concerning long-term intubation on 860 critically ill children admitted to our intensive care unit. Tube sizes were dictated by the modified Cole formula for uncuffed ETT (age [y]/4+4 mm ID) and chosen one-half size less for cuffed ETT. Cuff pressure was regularly monitored to maintain a small leak at peak inspiratory pressure. The choice of ETT was made by the physician responsible for the initial airway management.


RESULTS
There were 597 patients in the first 5 years of life, with 210 having cuffed ETT. There were no significant differences in the use of racemic epinephrine for postextubation subglottic edema, the rate of successful extubation or the need for tracheotomy between those with cuffed and uncuffed ETT in any age group.


CONCLUSIONS
Our data suggest that the traditional teaching in pediatric anesthesia and intensive care, including current pediatric life support recommendations, need to be reviewed for children to benefit from the advantages of modern low-pressure cuffed ETT during critical illnesses.
Division of Critical Care, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California 90027, USA. cnewth@chla.usc.edu
Christopher J l
CJ
Newth
Bonnie
B
Rachman
Neal
N
Patel
Jürg
J
Hammer
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation / Q000706:statistics & numerical data; D011446:Prospective Studies; D012135:Respiratory Sounds / Q000209:etiology*