Cuffed versus uncuffed endotracheal tubes for neonates

Dariya, Vedanta; Moresco, Luca; Bruschettini, Matteo; Brion, Luc P.

doi:10.1002/14651858.cd013736.pub2

Cited by 9 publications

(6 citation statements)

References 91 publications

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“…Evidence summary: Cuffed tracheal tubes are increasingly used in neonates, infants, and preschool children, with RCTs showing fewer tube exchanges for selecting the best size without affecting postextubation complications (Supplementary Table S7, http://links.lww.com/EJA/A891). 52–54 The effect of cuffed tubes on the incidence of postintubation stridor or complications in neo-nates remains unclear because of a lack of sufficient data 54–56 …”

Section: Methodsmentioning

confidence: 99%

“… 52 – 54 The effect of cuffed tubes on the incidence of postintubation stridor or complications in neo-nates remains unclear because of a lack of sufficient data. 54 – 56 …”

Section: Methodsmentioning

confidence: 99%

“…[52][53][54] The effect of cuffed tubes on the incidence of postintubation stridor or complications in neo-nates remains unclear because of a lack of sufficient data. [54][55][56] Retrospective studies and case series indicate the need to be vigilant regarding cuff inflation pressure limits. [57][58][59] There are insufficient data to support the routine use of a cuffed tracheal tube in children <3 kg with external tube diameter being the limiting factor.…”

Section: Pico 3 Tracheal Intubation Is Direct Laryngoscopy or Videola...mentioning

confidence: 99%

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Airway management in neonates and infants

Disma,

Asai,

Cools

et al. 2023

European Journal of Anaesthesiology

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Airway management is required during general anaesthesia and is essential for life-threatening conditions such as cardiopulmonary resuscitation. Evidence from recent trials indicates a high incidence of critical events during airway management, especially in neonates or infants. It is important to define the optimal techniques and strategies for airway management in these groups. In this joint European Society of Anaesthesiology and Intensive Care (ESAIC) and British Journal of Anaesthesia (BJA) guideline on airway management in neonates and infants, we present aggregated and evidence-based recommendations to assist clinicians in providing safe and effective medical care. We identified seven main areas of interest for airway management: i) preoperative assessment and preparation; ii) medications; iii) techniques and algorithms; iv) identification and treatment of difficult airways; v) confirmation of tracheal intubation; vi) tracheal extubation, and vii) human factors. Based on these areas, Population, Intervention, Comparison, Outcomes (PICO) questions were derived that guided a structured literature search. GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology was used to formulate the recommendations based on those studies included with consideration of their methodological quality (strong ‘1’ or weak ‘2’ recommendation with high ‘A’, medium ‘B’ or low ‘C’ quality of evidence). In summary, we recommend: 1. Use medical history and physical examination to predict difficult airway management (1С). 2. Ensure adequate level of sedation or general anaesthesia during airway management (1B). 3. Administer neuromuscular blocker before tracheal intubation when spontaneous breathing is not necessary (1С). 4. Use a videolaryngoscope with an age-adapted standard blade as first choice for tracheal intubation (1B). 5. Apply apnoeic oxygenation during tracheal intubation in neonates (1B). 6. Consider a supraglottic airway for rescue oxygenation and ventilation when tracheal intubation fails (1B). 7. Limit the number of tracheal intubation attempts (1C). 8. Use a stylet to reinforce and preshape tracheal tubes when hyperangulated videolaryngoscope blades are used and when the larynx is anatomically anterior (1C). 9. Verify intubation is successful with clinical assessment and end-tidal CO2 waveform (1C). 10. Apply high-flow nasal oxygenation, continuous positive airway pressure or nasal intermittent positive pressure ventilation for postextubation respiratory support, when appropriate (1B).

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Section: Methodsmentioning

confidence: 99%

“… 52 – 54 The effect of cuffed tubes on the incidence of postintubation stridor or complications in neo-nates remains unclear because of a lack of sufficient data. 54 – 56 …”

Section: Methodsmentioning

confidence: 99%

Section: Pico 3 Tracheal Intubation Is Direct Laryngoscopy or Videola...mentioning

confidence: 99%

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Airway management in neonates and infants

Disma,

Asai,

Cools

et al. 2023

European Journal of Anaesthesiology

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“…Dies ist insbesondere in Notfallsituationen und bei unerfahrenen Anwendern von Vorteil. Um eine Schädigung des Larynx und einen Postextubationstridor zu verhindern, müssen die Größenempfehlungen der Hersteller beachtet und bei gecufften Tuben auf die Grenzen des Cuff-Drucks unter Beachtung der Herstellerangaben geachtet werden (Cuff-Druck nie mehr als 20–30 cm H 2 O) [ 6 , 49 ]. Je nach Art und Hersteller des Tubus variieren die Außendurchmesser teilweise erheblich bei gleicher nomineller Tubusgröße (Innendurchmesser), was ebenso zu beachten ist.…”

Section: Endotracheale Intubation Beim Normalen Atemwegunclassified

Airway management in neonates and infants

Kaufmann,

Huber,

Engelhardt

et al. 2024

Anaesthesiologie

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ZusammenfassungDie Sicherung der Atemwege ermöglicht die Oxygenierung und Ventilation der Lungen und stellt eine potenziell lebensrettende medizinische Maßnahme dar. Insbesondere bei Neugeborenen und Säuglingen kommt es gehäuft zu unerwünschten und kritischen Ereignissen während des Atemwegsmanagements. Die multifaktoriellen Gründe dafür umfassen patientenabhängige, anwenderabhängige, aber auch externe Faktoren. Im Folgenden wird die neu erschienene internationale Leitlinie zur Atemwegssicherung bei Neugeborenen und Säuglingen fokussierend auf die klinische Anwendung zusammengefasst. Während die Originalpublikation der Leitlinie darauf fokussiert, auf Basis der systematisch erfassten Evidenz formale Empfehlungen zu benennen, stellt diese Zusammenfassung v. a. die Praktikabilität ihrer Umsetzung in den Fokus.

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“…As for today, there is no conclusive data on airway damage in infants resulting from cuffed ETTs ( 14 ). Tube insertion and maintenance can cause laryngeal edema.…”

Section: Introductionmentioning

confidence: 99%

Incidence of Post-extubation Stridor in Infants With Cuffed vs. Uncuffed Endotracheal Tube: A Retrospective Cohort Analysis

et al. 2022

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BackgroundEndotracheal 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.MethodsIn 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.ResultsA 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.ConclusionIn 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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Cuffed versus uncuffed endotracheal tubes for neonates

Cited by 9 publications

References 91 publications

Airway management in neonates and infants

Airway management in neonates and infants

Airway management in neonates and infants

Incidence of Post-extubation Stridor in Infants With Cuffed vs. Uncuffed Endotracheal Tube: A Retrospective Cohort Analysis

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