Anesth Essays Res. 2019 Jul-Sep;13(3):596-600. doi: 10.4103/aer.AER_97_19.

Microcuff Pediatric Endotracheal Tubes: Evaluation of Cuff Sealing Pressure, Fiber-optic Assessment of Tube Tip, and Cuff Position by Ultrasonography.

Ramachandran S¹, Mishra SK², Balachander H², Bidkar PU², Velayudhan S³, Parida S², Senthilnathan M².

Author information

1: Department of Anesthesiology and Critical Care, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India.
2: Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
3: Department of Anesthesiology and Critical Care, Indira Gandhi Medical College and Research Institute, Puducherry, India.

Abstract

Background:

Use of uncuffed tubes causes lots of morbidity, and there is a surge in the use of microcuff pediatric endotracheal tubes. These tubes are not evaluated in the Indian population.

Aims:

The study aimed to evaluate the pediatric microcuff endotracheal tubes in terms of cuff sealing pressure, fiber-optic assessment of tube tip, and cuff position to assess postextubation airway morbidity.

Settings and Design:

Study design involves follow-up analytical study.

Subjects and Methods:

Thirty-four children in the age group of 2-12 years were studied. Patients with leak pressure >20 cm H₂O were exchanged with smaller size tube and excluded. Cuff pressure, fiber-optic assessment of tube tip to carina distance in neutral and flexion, ultrasound assessment of cuff position, and postextubation airway morbidity were assessed.

Statistical Analysis Used:

Parameters expressed as the median with the interquartile range. Nonparametric data were analyzed using the Wilcoxon signed-rank test.

Results:

The tracheal leak pressure was <20 cm H₂O (median 14.5 cm H₂O) in 30 children. Tube exchange was required in four patients. A complete seal was achieved in 30 patients with cuff pressures ranging from 6 to 8.25 cm of H₂O (median 8 cm of H₂O). The median caudal displacement is 0.8 cm (0.47-1.22 cm) with flexion. There was no airway-related morbidity in any of these patients.

Conclusions:

The microcuff pediatric endotracheal tubes when used according to the age-based formula had a higher tube exchange rate in our study population. However, in children in whom the tube size was appropriate, the tubes provided good sealing without increasing airway morbidity. Further studies with a larger sample size might be required to confirm the findings.