Benefits of Using High-Volume–Low-Pressure Tracheal Tube in Children Undergoing Congenital Cardiac Surgery: Evidence From a Prospective Randomized Study

Abstract

Microcuff pediatric tracheal tube is associated with significantly lower incidence of stridor, tube changes, and anesthetic gas requirement. This leads to significant cost reduction that offsets the higher costs associated with usage of a microcuff tracheal tube.

Nasotracheal vs. Orotracheal Intubation and Post-extubation Airway Obstruction in Critically Ill Children: An Open-Label Randomized Controlled Trial

“…The lower rate of PEAO could be due to the fact that we used micro-cuffed endotracheal tubes (high-volume-low-pressure) in all cases as these were routinely available from the hospital supply during the study period. The use of micro-cuffed ETT may had led to lesser movement of ETT, lesser chances of unplanned extubation or ETT change, lower risk of laryngeal edema, and hence lower rates of PEAO ( 15 , 30 , 31 ). None of the Pediatric studies looked into the impact of nasotracheal intubation on the rate of PEAO, time taken for intubation, unplanned extubation, extubation failure, and other important clinical outcomes (duration of PICU stay and mortality).…”

Cuffed tracheal tubes: guilty now proven innocent

“…Sore throat was also less common after intubation with cuffed tubes, RR (95%CI) 0.32 (0.16–0.65), p < 0.001 . The rates of laryngospasm and stridor were similar when tracheas were intubated with cuffed or uncuffed tubes, RR (95%) 1.20 (0.85–1.70) and 0.78 (0.46–1.35), p = 0.64 and p = 0.19, respectively.…”

“…We systematically searched for and reviewed 10 randomised controlled trials in children in whom cuffed tracheal tubes were changed one‐sixth as often as uncuffed tubes, relative risk (95%CI) 0.17 (0.07–0.41), p < 0.001 (Fig. ) . Sore throat was also less common after intubation with cuffed tubes, RR (95%CI) 0.32 (0.16–0.65), p < 0.001 .…”

Pre-Extubation Cuffed Tube Leak Test and Subsequent Post-Extubation Laryngeal Edema: Prospective, Single-Center Evaluation of PICU Patients*

“…In the pediatric setting, cuffless endotracheal tubes (ETTs) have been used for more than half a century (1, 2), mainly because of concerns about potential damage to the airway mucosa caused by the cuff (3–6). However, the advent of thin polyurethane cuffed tubes (microcuff pediatric tracheal tubes [MPTTs]) with smaller, closer-to-the-tip cuffs and accumulating knowledge of their advantages have led to the general recommendation for using cuffed tubes in our PICU practice (1, 2, 7). For example, in the 2023 consensus recommendations for pediatric acute respiratory distress syndrome, the recommendation for cuffed ETTs is strongly agreed upon (8).…”