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Incidence of aspiration in endotracheally intubated infants and children
Insights
Non-cuffed endotracheal tubes effectively prevent aspiration in pediatric intensive care unit patients. Proper sizing ensures a seal, minimizing risks like pneumonia in intubated infants and children.
Area of Science:
- Pediatric critical care medicine
- Respiratory medicine
- Otolaryngology
Background:
- Aspiration is a significant risk for intubated infants and children.
- Non-cuffed endotracheal tubes are commonly used in pediatric intensive care units (PICUs).
- Assessing aspiration incidence is crucial for patient safety and outcomes.
Purpose of the Study:
- To determine the incidence of aspiration in infants and children intubated with non-cuffed endotracheal tubes.
- To evaluate the effectiveness of non-cuffed endotracheal tubes in preventing aspiration.
- To identify factors influencing aspiration in this patient population.
Main Methods:
- Prospective study of 50 infants and children in a multidisciplinary PICU.
- Aspiration assessment using Evans blue dye applied to the tongue, detected in endotracheal aspirates.
- Data collected on patient demographics, indications for intubation, and duration of ventilation.
Main Results:
- Aspiration was detected in 16% of patients.
- Aspiration events were associated with chest X-ray changes in 63% and decreased PO2 in 37% of affected patients.
- Nasogastric tube presence, consciousness level, and ventilator settings did not significantly impact aspiration rates.
Conclusions:
- Non-cuffed endotracheal tubes, when properly sized, effectively seal the trachea.
- These tubes can prevent clinically significant aspiration in intubated infants and children.
- Ensuring adequate tube sizing is key to mitigating aspiration risks in pediatric critical care.
Abstract:
A prospective study is reported to examine the incidence of aspiration in 50 infants and children intubated with a noncuffed endotracheal tube in a multidisciplinary PICU. Aspiration was assessed by applying Evans blue dye on the tongue and searching for the dye during suctioning, in the endotracheal aspirate. Twenty-nine (58%) were medical patients and 21 (42%) surgical; ages ranged between 25 h and 4 yr (mean 18.5 months). Respiratory failure was the major indication for endotracheal intubation and mechanical ventilation in 26 (52%) of the patients, hyperventilation for increased intracranial pressure in 12 (24%), congestive heart failure in 8 (16%), and protection of airway in deeply comatose patients in 4 (8%). The patients remained intubated from 18 h to 12 days (mean 70.4 h). Evidence of aspiration was found in 8 (16%) of the patients, accompanied by changes in chest x-ray in 5 (63%) patients and a significant fall in PO2 in 3 (37%). Aspiration was not significantly affected by the presence of a nasogastric tube, level of consciousness or ventilator setting. We conclude that noncuffed endotracheal tubes of proper size that adequately seal the trachea and effectively prevent clinically significant aspiration in endotracheally intubated infants and children.