title: Comparison of cuffed and uncuffed preformed oral pediatric tracheal tubes.
abstract: BACKGROUND
  In preformed cuffed tracheal tubes the position of the cuff within the airway is given by its distance to the tube bend placed at the lower teeth. The aim of this study was to compare the design of cuffed and uncuffed preformed pediatric oral tracheal tubes with regard to anatomical landmarks.
  
  
  METHODS
  Complete series of cuffed and uncuffed preformed oral pediatric tracheal tubes sized from internal diameter 3.0-7.0 mm if available were ordered from five different manufacturers. The distance from the bend to the distal tube tip and to the upper border of the cuff were measured and compared with anatomical airway landmarks in the developing child.
  
  
  RESULTS
  Between cuffed and uncuffed tracheal preformed tubes up to 37 mm differences in the bend-to-tracheal tube tip distances were found for given age groups. Thus uncuffed preformed tracheal tubes were more at risk for inadvertent endobronchial intubation than cuffed preformed tracheal tubes. Comparison of bend-to-upper border of the cuff distances with teeth-to-vocal cord distances calculated from anatomical data revealed that several of the tracheal tube cuffs become positioned within the subglottic larynx or even within the vocal cords when inserted according to the bend.
  
  
  CONCLUSIONS
  There is a need for improvement in cuffed preformed pediatric tracheal tubes, namely a standard bend-to-tracheal tube tip distance to allow a safe insertion depth, a short cuff placed on the tube shaft as distally as possible and an intubation depth mark to verify a proper position of the cuff in the trachea.
authors.affiliation: Department of Anaesthesia, University Children's Hospital, Zurich, Switzerland. markus.weiss@kispi.unizh.ch
authors.forename: Markus
authors.initials: M
authors.lastname: Weiss
authors.forename: Vera
authors.initials: V
authors.lastname: Bernet
authors.forename: Katharina
authors.initials: K
authors.lastname: Stutz
authors.forename: Alexander
authors.initials: A
authors.lastname: Dullenkopf
authors.forename: Paolo
authors.initials: P
authors.lastname: Maino
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D007830:Larynx / Q000033:anatomy & histology; D014070:Tooth / Q000033:anatomy & histology; D014132:Trachea / Q000033:anatomy & histology; D014827:Vocal Cords / Q000033:anatomy & histology