Cuffed endotracheal tubes in infants less than 3 kg: A retrospective cohort study
Rebecca E Thomas1,2, Shripada C Rao1,2, Corrado Minutillo1
1Neonatal Clinical Care Unit, Princess Margaret Hospital for Children and King Edward Memorial Hospital for Women, Perth, WA, Australia.
Insights
Microcuff cuffed endotracheal tubes appear safe for neonates under 3 kg, showing no increased risk of complications. Further randomized controlled trials are recommended for definitive evidence on their use in this vulnerable population.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Respiratory Support
Background:
- Cuffed endotracheal tubes (ETTs) are increasingly used in infants.
- Existing evidence primarily focuses on infants weighing 3 kg or more.
- Data on the safety and efficacy of cuffed ETTs in neonates under 3 kg is limited.
Purpose of the Study:
- To compare short-term outcomes of Microcuff cuffed versus uncuffed ETTs in neonates weighing less than 3 kg.
- To evaluate the safety and effectiveness of cuffed ETTs in a low-birth-weight neonatal population.
Main Methods:
- Retrospective cohort study conducted in a single tertiary children's hospital neonatal intensive care unit.
- Inclusion of neonates (< 3 kg) who received Microcuff cuffed ETTs (January 2015 - January 2016).
- Comparison with a control group of neonates (2000-2999 g) who received uncuffed ETTs (September 2015 - January 2016).
Main Results:
- No significant differences were observed in weight, duration of intubation, or rates of ETT size changes, ventilator leaks, unplanned extubations, or pneumonia between cuffed and uncuffed ETT groups.
- A higher incidence of atelectasis was noted in the cuffed ETT group (4/23 vs 0/23).
- The study included 23 neonates in each group, with cuffed ETTs primarily inflated in the operating room.
Conclusions:
- Microcuff cuffed endotracheal tubes may be a safe option for neonates weighing less than 3 kg.
- The small sample size necessitates further investigation.
- Well-designed randomized controlled trials are required to definitively confirm the safety and efficacy of cuffed ETTs in this population.
Background:
Cuffed endotracheal tubes are being increasingly used in infants; however, current evidence in the literature mostly includes infants ≥ 3-kg weight.
Aims:
The aim of this observational study was to compare the short-term outcomes with the use of Microcuff® cuffed vs uncuffed endotracheal tubes in neonates < 3 kg.
Methods:
We performed a retrospective cohort study in a single-centre, tertiary children's hospital neonatal intensive care unit. The study included all infants < 3 kg receiving Microcuff® cuffed endotracheal tubes over the period January 2015 to January 2016. Controls were all infants 2000-2999 g receiving an uncuffed endotracheal tube over the period September 2015 to January 2016.
Results:
Twenty-three patients < 3 kg were intubated with cuffed endotracheal tubes. All were inserted in the operating room. Of 23 patients, 14 (60.9%) patients had the cuff inflated in the operating room and none subsequently in the neonatal intensive care unit. The group receiving cuffed endotracheal tubes was compared with 23 patients with uncuffed endotracheal tubes. There was no difference in weight (median 2620 g vs 2590 g, diff in median = 10, 95% CI -120, 130) or duration of intubation (median 27 vs 44 hours, diff in median = 17, 95% CI -5, 46). However, there was a significant difference in gestational age (median 37 vs 35 weeks, diff in median = -1, 95% CI -2, 0) and age at intubation (median 6 vs 0 days, diff in median = -4, 95% CI -10, -1). There were no significant differences in the rates of: change of endotracheal tube to find correct size (0/23 vs 4/23, P = .109, OR = 0.13, 95% CI 0.01, 1.41); median ventilator leak reading (0% [IQR 0%-12%] vs 0% [IQR 0%-5.5%], P = .201, diff in median = 0, 95% CI -5.5, 0); unplanned extubations (0/23 vs 2/23; atelectasis (4/23 vs 0/23; endotracheal tube blockage (0/23 vs 0/23; pneumonia (0/23 vs 0/23; or postextubation stridor (1/23 vs 2/23).
Conclusion:
This retrospective study with a small sample size found that Microcuff® cuffed endotracheal tubes may be safe in neonates < 3 kg. Well-designed randomized controlled trials are needed to address this issue definitively.
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