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Incidence of Post-extubation Stridor in Infants With Cuffed vs. Uncuffed Endotracheal Tube: A Retrospective Cohort
Katharina Bibl1, Lena Pracher1, Erik Küng1
1Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.
Insights
Cuffed endotracheal tubes (ETT) in infants weighing 2-6 kg showed no increased risk of post-extubation stridor compared to uncuffed ETTs. Uncuffed ETTs did not correlate with a higher incidence of subglottic stenosis in this cohort.
Area of Science:
- Neonatal Intensive Care
- Pediatric Critical Care
- Respiratory Medicine
Background:
- Endotracheal intubation (ETT) is standard in adults but controversial in infants.
- Cuffed ETTs are widely used in adults and children, but their safety in neonates requires further investigation.
- This study addresses the controversy surrounding cuffed vs. uncuffed ETTs in infant intubation.
Purpose of the Study:
- To compare post-extubation stridor incidence between cuffed and uncuffed ETTs in infants.
- To assess the safety of cuffed ETTs in infants weighing 2-3 kg.
- To analyze the development of subglottic stenosis in relation to ETT type.
Main Methods:
- Retrospective study of infants (2-6 kg bodyweight) undergoing first intubation in two NICUs (2012-2019).
- Post-extubation stridor defined by epinephrine or corticosteroid administration within 6 hours.
- Subglottic stenosis cases were identified regardless of bodyweight or intubation number.
Main Results:
- 271 infants analyzed (92 cuffed, 179 uncuffed ETTs).
- Seven infants (2.6%) developed stridor; 5 with cuffed, 2 with uncuffed ETTs (p=0.053).
- Subglottic stenosis was more frequent with uncuffed ETTs.
Conclusions:
- No significant difference in post-extubation stridor incidence between cuffed and uncuffed ETTs in infants (2-6 kg).
- Cuffed ETTs do not increase the risk of subglottic stenosis in this infant cohort.
- Findings suggest cuffed ETTs may be safely used in infants within the studied weight range.
Background:
Endotracheal intubation is a common procedure in Neonatal Intensive Care. While cuffed endotracheal tubes (ETT) are the standard of care in adults and children, their use in infants is controversial. The aim of this study was to compare the incidence of post-extubation stridor between uncuffed and cuffed ETTs in infants. We further evaluated the safety of cuffed ETTs in infants with a bodyweight between 2 and 3 kg and performed baseline analysis on development of subglottic stenosis.
Methods:
In this retrospective study, we screened all infants admitted to two NICUs of the Medical University of Vienna between 2012 and 2019.The study cohort was screened twice: In the first screening we selected all infants who underwent the first intubation when attaining a bodyweight >2 kg (but <6 kg) to analyze the incidence of post-extubation stridor and only considered the first intubation of each included infant. Post-extubation stridor was defined as the administration of either epinephrine aerosol or any corticosteroid within 6 h post-extubation. In the second screening we searched for all infants diagnosed with acquired severe subglottic stenosis during the study period regardless their bodyweight and numbers of intubations.
Results:
A total of 389 infants received at least one intubation during the study period. After excluding infants who underwent the first intubation below a bodyweight of 2 kg, 271 infants remained for final analysis with an average gestational age of 38.7 weeks at the time of intubation. Among those, 92 (33.9%) were intubated with a cuffed and 179 (66.1%) with an uncuffed ETT. Seven infants (2.6%) developed a clinically significant stridor: five of those were intubated with a cuffed and two with an uncuffed ETT (71.4 vs. 28.6%, p = 0.053). All of them had a bodyweight >3 kg at the time of intubation. Infants who developed subglottic stenosis were more often intubated with an uncuffed ETT.
Conclusion:
In this study, no difference in the incidence of post-extubation stridor between cuffed and uncuffed ETTs in infants with a bodyweight from 2 to 6 kg could be found. The use of uncuffed ETTs does not exhibit higher risk for the acquired subglottic stenosis in this cohort.
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