title: Cuffed endotracheal tubes in neonates and infants undergoing cardiac surgery are not associated with airway complications.
abstract: OBJECTIVE
  To determine the incidence of postoperative airway complications in infants <5kg in weight undergoing cardiac surgery intubated with Microcuff (Kimberley-Clark, Roswell, GA) endotracheal tubes (ETTs).
  
  
  METHODS
  Retrospective review of infants weighing <5.0 kg with congenital heart disease (CHD) presenting for cardiac surgery.
  
  
  METHODS
  Single-center, tertiary pediatric cardiac critical care unit at a university hospital.
  
  
  METHODS
  A total of 208 infants weighing <5 kg underwent cardiac surgery for CHD from 2008 to 2013.
  
  
  METHODS
  Intubation with Microcuff (Kimberley-Clark) ETTs.
  
  
  METHODS
  Retrospective review of infants weighing <5.0 kg with CHD presenting for cardiac surgery to a single-center tertiary care university hospital.
  
  
  METHODS
  Perioperative data were collected. Primary outcome was development of tracheal stenosis and/or reintubation for stridor. Stridor was defined as mild (≤2 doses of racemic epinephrine), moderate (>2 doses of racemic epinephrine), or severe (requiring reintubation). Secondary outcomes were variables possibly contributing to postextubation stridor. Infants with a tracheostomy, airway anomalies, and death prior to initial extubation were excluded. Logistic regression analysis was performed to evaluate the association between clinical risk factors and the incidence of postextubation stridor.
  
  
  RESULTS
  A total of 208 infants weighing <5 kg underwent cardiac surgery for CHD from 2008 to 2013; 12 subjects were excluded for death prior to initial extubation. No infant developed tracheal stenosis. The incidence of any stridor was 20.9% (95% confidence interval, 15.8%-27.1%) with severe stridor in 2 cases (1%). Age at surgery, weight, duration of intubation, dexamethasone use, and ETT size were not significantly associated with postextubation stridor. Presence of a comorbidity was significantly associated with stridor (P=.01).
  
  
  CONCLUSIONS
  Microcuff ETTs in infants <5.0 kg in weight undergoing cardiac surgery are associated with a low incidence of severe postextubation stridor. Because cuffed ETTs allow for improved control of ventilation/oxygenation and decreased risk of aspiration, they should be considered for use in this high-risk population. Larger studies are needed to confirm these results.
authors.affiliation: Departments of Pediatrics, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA. Electronic address: Jennifer_demichele@urmc.rochester.edu.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: DeMichele
authors.affiliation: Department of Anesthesiology, Rush-Copley Medical Center, 2000 Ogden Ave, Aurora, IL, USA. Electronic address: nvajaria@gmail.com.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Vajaria
authors.affiliation: Department of Statistics, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA. Electronic address: Hongyue_Wang@URMC.Rochester.edu.
authors.forename: Hongyue
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, USA. Electronic address: Dawn_Sweeney@URMC.Rochester.edu.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Sweeney
authors.affiliation: Departments of Pediatrics, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA. Electronic address: Karen_Powers@URMC.Rochester.edu.
authors.forename: Karen S
authors.initials: KS
authors.lastname: Powers
authors.affiliation: Departments of Pediatrics, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA. Electronic address: Jill_Cholette@URMC.Rochester.edu.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Cholette
mesh_terms: D058109:Airway Management / Q000009:adverse effects* / Q000379:methods*; D000402:Airway Obstruction / Q000209:etiology*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation; D008297:Male; D010100:Oxygen / Q000097:blood; D012121:Respiration, Artificial; D012135:Respiratory Sounds; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D010100:Oxygen
keywords: Congenital heart disease; Endotracheal intubation; Pediatric anesthesia; Postextubation stridor