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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.

Author information

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



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.


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.


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.


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.


Airway anatomy; cuff pressure; microcuff tube; pediatric endotracheal tubes

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