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Published on: January 17, 2011
Perioperative use of cuffed endotracheal tubes is advantageous in young pediatric burn patients
David P Dorsey1, Stephen M Bowman, Matthew B Klein
1School of Medicine, University of Washington, Seattle, WA 98104, USA.
Insights
In pediatric burn patients, uncuffed endotracheal tubes increase risks of tidal volume loss and reintubation compared to cuffed tubes. Cuffed tubes are recommended for safer airway management in this vulnerable population.
Area of Science:
- Pediatric Anesthesiology
- Critical Care Medicine
- Burn Surgery
Background:
- Traditionally, uncuffed endotracheal tubes were favored for pediatric patients.
- Recent evidence challenges this preference in elective surgical settings.
- Pediatric burn patients present unique airway and ventilation challenges.
Purpose of the Study:
- To compare adverse events of cuffed versus uncuffed endotracheal tubes in pediatric burn patients.
- To evaluate airway outcomes in burned children aged 0-10 years undergoing intubation.
- To inform best practices for airway management in this specific population.
Main Methods:
- Retrospective review of 327 operating room intubations in burned children (0-10 years) over 10 years.
- Comparison of clinical airway outcomes between cuffed and uncuffed endotracheal tube use.
- Multivariable logistic regression analysis controlling for patient and injury characteristics.
Main Results:
- Children receiving uncuffed tubes had significantly higher odds of clinically significant tidal volume loss (OR 10.62).
- Uncuffed tubes were associated with significantly higher odds of requiring immediate reintubation (OR 5.54).
- No significant difference in post-extubation stridor rates was observed between groups.
Conclusions:
- Perioperative use of uncuffed endotracheal tubes in pediatric burn patients is linked to increased tidal volume loss and reintubation.
- Cuffed endotracheal tubes may offer improved airway security and reduced manipulation in this population.
- Emphasis on cuffed tube use is suggested for managing challenging airways in pediatric burn patients.
Abstract:
Uncuffed endotracheal tubes traditionally have been preferred over cuffed endotracheal tubes in young pediatric patients. However, recent evidence in elective pediatric surgical populations suggests otherwise. Because young pediatric burn patients can pose unique airway and ventilation challenges, we reviewed adverse events associated with the perioperative use of cuffed and uncuffed endotracheal tubes. We retrospectively reviewed 327 cases of operating room endotracheal intubation for general anesthesia in burned children 0-10 years of age over a 10-year period. Clinical airway outcomes were compared using multivariable logistic regression, controlling for relevant patient and injury characteristics. Compared to those receiving cuffed tubes, children receiving uncuffed tubes were significantly more likely to demonstrate clinically significant loss of tidal volume (odds ratio 10.62, 95% confidence interval 2.2-50.5) and require immediate reintubation to change tube size/type (odds ratio 5.54, 95% confidence interval 2.1-13.6). No significant differences were noted for rates of post-extubation stridor. Our data suggest that operating room use of uncuffed endotracheal tubes in such patients is associated with increased rates of tidal volume loss and reintubation. Due to the frequent challenge of airway management in this population, strategies should emphasize cuffed endotracheal tube use that is associated with lower rates of airway manipulation.
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