What is the difference between cuffed and uncuffed et tubes

Equality of breath sounds was checked to ensure that the endotracheal tubes were in the trachea. The number of attempts needed to arrive at the final endotracheal tube size were recorded in both groups. Ohmeda anesthesia ventilators Ohmeda, Columbia, MD were set to maintain adequate oxygenation and carbon dioxide elimination. Fresh gas flow rates of 2 1 [center dot] min sup -1 were used, if possible, to keep the ventilator bellows up, and were then recorded.

In a subset of patients selected at random using an Ohio Trace Gas Analyzer, nitrous oxide concentrations at 6 and 24 inches away from the patients's mouth were measured 10—15 min after tracheal intubation. All anesthesia machines are equipped with a waste gas scavenging system. Our operating rooms have volumes between m 3 and 3 and are ventilated with at least 12 air exchanges per hour.

All hoses and equipment are routinely maintained and inspected for leaks. All patients' tracheas were extubated in the operating room after completion of the surgical procedure. The duration of intubation was recorded.

Patients were observed for evidence of croup during their hospital stay. The presence of stridor, a persistent barking or brassy cough, sternal or intercostal retractions, and treatment or unplanned admission for croup were recorded.

The data were analyzed using a two-tailed Student's t test for continuous parametric variables, Mann-Whitney U test for nonparametric variables, and chi-square analysis with Yates correction for nominal variables. There were patients in the cuffed tube group and patients in the uncuffed tube group.

Age, weight, duration of intubation, and surgical procedure were comparable for the two groups Table 2 and Table 3. The number of patients who required tracheal reintubation to place an appropriately sized tube was significantly greater in the uncuffed tube group than in the cuffed tube group Table 4.

The three patients in the cuffed tube group who required a second tube were 3, 4, and 6 yr of age and required placement of an tracheal tube one size 0. In the uncuffed tube group, a larger tube was placed in 13 5. More patients in the uncuffed tube group required a fresh gas flow greater than 2 1 [center dot] min sup -1 to maintain inflation of the bellows on the anesthesia ventilator Table 4.

Nitrous oxide concentrations in the operating room were measured during the care of 39 patients in the cuffed tube group and 40 patients in the uncuffed tube group.

This subset of patients was similar to the overall population in terms of age. The distribution of nitrous oxide concentrations at 24 inches from the patient's mouth is shown in Table 5. Nitrous oxide concentration at 24 inches, which approximates the anesthesiologist's breathing zone, were compared with the NIOSH limit for time-weighted exposure of 25 parts per million ppm. Six patients 2. Of these patients, three patients in each group were treated with racemic epinephrine.

For one patient in each group, diagnosis of croup was involved in the decision for hospital admission. None of these patients required tracheal reintubation for croup. One of the two patients admitted for croup was 2 yr old, had multiple medical problems, was small for age, and had a history of croup.

This child was tracheally intubated with a 3. The other was a 1-yr-old child with a preoperative upper respiratory tract infection undergoing an adenoidectomy, and whose trachea was intubated with a 4. There was no significant difference detected between the groups with regard to incidence of croup. Pediatric anesthesiologists routinely change endotracheal tubes to achieve an appropriate fit. Using the protocol-defined choice of initial tube and reintubation criteria, we demonstrated that use of cuffed endotracheal tubes, which have an adjustable outer dimension and shape, almost eliminates the need to replace the initial tube.

Our formula for the size of the initial cuffed tube was based on the experience in our hospital. A variety of formulae are used to calculate uncuffed endotracheal tube size. We chose the commonly used modification of the age-based formula proposed by Cole for calculating uncuffed tube size in all patients, except those younger than 1 yr.

Our belief that this closely approximates common practice is least certain in children younger than 2 yr. However, our results retain significance when children younger than 2 yr are excluded from the analysis.

Our criteria for replacement of uncuffed tubes used a leak test, which is an imprecise way to calibrate tube size because of significant interobserver variability, [5] but reflects common pediatric anesthesia practice.

Although reintubation rates are not directly reported, several studies suggest that calculated tube sizes are frequently inappropriate. Koka et al. Mukubo et al. We measured ambient nitrous oxide 24 inches away from the patient's mouth during a steady state of anesthesia.

Wood et al. Entwistle, J. A review of cuffed vs uncuffed endotracheal tubes in children. Pediatric Anesthesia and Critical Care Journal, 2 2 , Khine, H. Anesthesiology, 86 3 , Rafidi, A. For Decision Makers in Respiratory Care , Shi, F.

Cuffed versus uncuffed endotracheal tubes in children: A meta-analysis. Journal of Anesthesia, 30 1 , This is an interesting paper to open the discussion around the use of cuffed ETTs in neonates.

I would love to see other data to enhance this paper: comparison with rates of SGS prior to cuffed tubes and comparison of rates of SGS in other patients who did have an uncuffed tube but did not develop SGS. Surely in the or so intubations, there would have been others who were also tubed with uncuffed tube and yet not develop any tube related pathology. Although this is not a perfect paper, I do think the authors are onto something, and that they are adding to the body of knowledge suggesting that in their cohort, cuffed tubes are not associated with SGS.

Your email address will not be published. Save my name, email, and website in this browser for the next time I comment. One of the key determinants is the careful management inflation pressures of the cuff Both over and under inflation of the cuff increase risk of subglottic pathology. Now we have low pressure cuffs the risk of sub-glottic stenosis is low.

Uncuffed tubes appear to be more risky. Cuffed tubes are usually half a size smaller than uncuffed tubes. Cuffed or uncuffed tubes? Tessa Davis. Cite this article as:. Share on facebook. Share on twitter.

Share on linkedin. Share on whatsapp. Comment These findings add to mounting evidence rejecting the old dogma about use of cuffed tubes in children. Citation s : Chambers NA et al. October 15, Wilmington, North Carolina. Family Medicine. Waverly, New York. New York City, New York. Faculty Position in Cardiology and Echocardiography.