Cuffed endotracheal tubes in infants and children: should we routinely measure the cuff pressure?
OBJECTIVE
Over the past 5 years, there has been a change in the clinical practice of pediatric anesthesiology with a transition to the use of cuffed instead of uncuffed endotracheal tubes in infants and children. However, there are few studies evaluating the current practices of inflation of these cuffs and the intracuff pressures.


METHODS
There was no change dictated in clinical practice for these patients. During the first 30 min of the case, the pressure in the cuff was measured using a hand held manometer. Additional data collected included the patient's demographic data (age, weight, and gender), the size of the ETT, whether nitrous oxide was in use, whether the patient was breathing spontaneously or undergoing positive pressure ventilation, and the type of anesthesia provider (resident, fellow, CRNA or SRNA).


RESULTS
The cohort for the study included 200 patients ranging in age from 1 month to 17 years and in weight from 3.5 to 99.1 kg. The average cuff pressure was 23 ± 22 cmH(2)O in the total cohort of 200 patients. The cuff pressure was ≥ 30 cmH(2)O in 47 of the 200 patients (23.5%). The average cuff pressure was significantly higher in patients who were 8 years of age or greater compared to younger patients. Additionally, there were significantly more patients with a cuff pressure ≥ 30 cmH(2)O in the ≥ 8 year old age group. Although no difference in the mean cuff pressure was noted when comparing staff anesthesia providers (pediatric anesthesiologist or CRNA) versus trainees (SRNA, anesthesiology resident, medical student or pediatric anesthesiology fellow), the incidence of significantly excessive cuff pressures (≥ 60 cmH(2)O) was higher in the trainee group versus the faculty group (12 of 99 versus 2 of 101, p<0.0001).


CONCLUSIONS
Using current clinical practice to inflate the cuff, a significant percentage of pediatric patients have an intracuff pressure greater than the generally recommended upper limit of 30 cmH(2)O.
Department of Anesthesiology, Nationwide Children's Hospital and Ohio State University, Columbus, OH 43205, United States. Joseph.Tobias@Nationwidechildrens.org
Joseph D
JD
Tobias
Lawrence
L
Schwartz
Julie
J
Rice
Kris
K
Jatana
D Richard
DR
Kang
D000293:Adolescent; D000770:Anesthesia, Endotracheal / Q000295:instrumentation* / Q000379:methods; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008365:Manometry / Q000295:instrumentation; D009609:Nitrous Oxide / Q000008:administration & dosage; D061214:Patient Safety; D010372:Pediatrics / Q000592:standards / Q000639:trends; D011312:Pressure
D018685:Anesthetics, Inhalation; D009609:Nitrous Oxide