title: Prospective randomized controlled multi-centre trial of cuffed or uncuffed endotracheal tubes in small children.
abstract: BACKGROUND
  The use of cuffed tracheal tubes (TTs) in small children is still controversial. The aim of this study was to compare post-extubation morbidity and TT exchange rates when using cuffed vs uncuffed tubes in small children.
  
  
  METHODS
  Patients aged from birth to 5 yr requiring general anaesthesia with TT intubation were included in 24 European paediatric anaesthesia centres. Patients were prospectively randomized into a cuffed TT group (Microcuff PET) and an uncuffed TT group (Mallinckrodt, Portex, Rüsch, Sheridan). Endpoints were incidence of post-extubation stridor and the number of TT exchanges to find an appropriate-sized tube. For cuffed TTs, minimal cuff pressure required to seal the airway was noted; maximal cuff pressure was limited at 20 cm H(2)O with a pressure release valve. Data are mean (SD).
  
  
  RESULTS
  A total of 2246 children were studied (1119/1127 cuffed/uncuffed). The age was 1.93 (1.48) yr in the cuffed and 1.87 (1.45) yr in the uncuffed groups. Post-extubation stridor was noted in 4.4% of patients with cuffed and in 4.7% with uncuffed TTs (P=0.543). TT exchange rate was 2.1% in the cuffed and 30.8% in the uncuffed groups (P<0.0001). Minimal cuff pressure required to seal the trachea was 10.6 (4.3) cm H(2)O.
  
  
  CONCLUSIONS
  The use of cuffed TTs in small children provides a reliably sealed airway at cuff pressures of <or=20 cm H(2)O, reduces the need for TT exchanges, and does not increase the risk for post-extubation stridor compared with uncuffed TTs.
authors.affiliation: Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland. markus.weiss@kispi.uzh.ch
authors.forename: M
authors.initials: M
authors.lastname: Weiss
authors.forename: A
authors.initials: A
authors.lastname: Dullenkopf
authors.forename: J E
authors.initials: JE
authors.lastname: Fischer
authors.forename: C
authors.initials: C
authors.lastname: Keller
authors.forename: A C
authors.initials: AC
authors.lastname: Gerber
mesh_terms: D000399:Air Pressure; D000768:Anesthesia, General; D002675:Child, Preschool; D020878:Device Removal; D004867:Equipment Design; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D012135:Respiratory Sounds / Q000209:etiology; D016896:Treatment Outcome