Shortcomings of cuffed paediatric tracheal tubes

The goal of this investigation was to evaluate adequacy of the design of readily available paediatric cuffed tracheal tubes (CPTT).

In 15 series of cuffed (11) and uncuffed (four) paediatric tracheal tubes (ID: 2.5-7.0 mm) from four different manufacturers the following dimensions were measured: outer diameter of the tube, position and largest diameter of the tube cuff inflated at 20 cm H(2)O and position of depth markings and compared with age-related dimensions.

Outer diameters for tubes with similar IDs varied markedly between manufacturers and between cuffed and uncuffed tracheal tubes from the same manufacturer. Cuff diameters at 20 cm H(2)O cuff pressure and cross-sectional cuff area at 20 cm H(2)O cuff pressure did not always cover maximal internal age-related tracheal diameters and cross-sectional areas. Placing the tube tip in the mid-trachea, the cuffs of cuffed tubes with ID 3.0, 4.0, or 5.0 mm would become positioned within the larynx. If the cuffs were placed 1 cm below the cricoid level, many of the tube tips would be dangerously deep within the trachea. Only five of the 11 cuffed tubes had a depth marking. In many of these tubes the distances from depth marking to tube tip were greater than the age-related minimal tracheal length.

Most cuffed paediatric tracheal tubes are poorly designed, in particular the smaller sizes. A better design of cuffed tubes with a short high-volume, low-pressure cuff, cuff-free subglottic space and adequately placed depth markings are urgently needed.