Related Experiment Videos
Cuffed endotracheal tubes in pediatric intensive care
T W Deakers1, G Reynolds, M Stretton
1Division of Pediatric Intensive Care, Children's Hospital of Los Angeles, University of Southern California School of Medicine 90027.
Insights
Cuffed endotracheal tubes (ETTs) in pediatric intensive care did not increase postextubation stridor risk compared to uncuffed ETTs. Long-term outcomes were also similar, showing no increased risk with cuffed ETT use.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Medical Devices
Background:
- Endotracheal intubation is common in pediatric intensive care units (PICUs).
- The choice between cuffed and uncuffed endotracheal tubes (ETTs) impacts patient outcomes.
- Postextubation stridor is a significant concern following tracheal intubation.
Purpose of the Study:
- To compare the utilization and outcomes of cuffed versus uncuffed endotracheal tubes (ETTs) in a pediatric intensive care unit (PICU).
- To determine if cuffed ETTs increase the incidence of postextubation stridor compared to uncuffed ETTs, controlling for patient risk factors.
Main Methods:
- Prospective study of 282 tracheal intubations in 243 pediatric patients over 7 months.
- Compared incidence of postextubation stridor between cuffed and uncuffed ETT groups.
- Controlled for patient age, duration of intubation, trauma, ETT leak, and Pediatric Risk of Mortality score.
Main Results:
- Overall postextubation stridor incidence was 14.9% with no significant difference between cuffed and uncuffed ETT groups.
- Cuffed ETTs were used in older children and for longer durations.
- Reintubation rates for stridor and long-term sequelae like readmission or tracheostomy were not significantly increased with cuffed ETTs.
Conclusions:
- Cuffed endotracheal intubation in the pediatric intensive care setting is not associated with an increased risk of postextubation stridor.
- The use of cuffed ETTs does not lead to significant long-term adverse upper airway sequelae.
- Cuffed ETTs can be safely utilized in pediatric patients without compromising airway outcomes.
Abstract:
We prospectively studied 282 consecutive tracheal intubations (243 patients) in a pediatric intensive care unit during a 7-month period to compare cuffed and uncuffed endotracheal tube (ETT) utilization and outcome. The incidence of postextubation stridor in each ETT group was the major outcome measure after controlling for various patient risk factors. Patients whose ETTs were inserted in the operating room, who were less than 1 year of age, or who had ETTs in place for less than 72 hours were more likely to have had insertion of an uncuffed ETT. Patients whose ETTs were inserted in the emergency department or who were more than 5 years of age were more likely to have had insertion of a cuffed ETT. Those who had a cuffed ETT were older (mean 8.1 vs 2.5 years) and had ETTs in place longer (mean 6.1 vs 3.7 days) than patients with an uncuffed ETT. Of the 188 patients who subsequently had removal of their ETTs, the overall incidence of postextubation stridor was 14.9%, with no significant difference between the two ETT groups even after controlling for patient age, duration of intubation, trauma, leak around ETT before extubation, and pediatric risk of mortality score. Two patients in the cuffed ETT group and four patients in the uncuffed ETT group required reintubation for severe postextubation stridor. Long-term follow-up identified 33 patients (17%) who required hospital readmission. None of these was admitted with an upper airway problem. Two patients who previously had insertion of a cuffed ETT subsequently received tracheostomies for the primary purpose of long-term mechanical ventilation unrelated to any problem with the upper airway. We conclude that cuffed endotracheal intubation is not associated with an increased risk of postextubation stridor or significant long-term sequelae.