Cuffed endotracheal tubes in pediatric intensive care,☆☆,

https://doi.org/10.1016/S0022-3476(94)70121-0Get rights and content

Abstract

We prospectively studied 282 consecutive tracheal intubations (243 patients) in a pediatric intensive care unit during a 7-month period to compare cuffed and uncuffed endotracheal tube (ETT) utilization and outcome. The incidence of postextubation stridor in each ETT group was the major outcome measure after controlling for various patient risk factors. Patients whose ETTs were inserted in the operating room, who were less than 1 year of age, or who had ETTs in place for less than 72 hours were more likely to have had insertion of an uncuffed ETT. Patients whose ETTs were inserted in the emergency department or who were more than 5 years of age were more likely to have had insertion of a cuffed ETT. Those who had a cuffed ETT were older (mean 8.1 vs 2.5 years) and had ETTs in place longer (mean 6.1 vs 3.7 days) than patients with an uncuffed ETT. Of the 188 patients who subsequently had removal of their ETTs, the overall incidence of postextubation stridor was 14.9%, with no significant difference between the two ETT groups even after controlling for patient age, duration of intubation, trauma, leak around ETT before extubation, and pediatric risk of mortality score. Two patients in the cuffed ETT group and four patients in the uncuffed ETT group required reintubation for severe postextubation stridor. Long-term follow-up identified 33 patients (17%) who required hospital readmission. None of these was admitted with an upper airway problem. Two patients who previously had insertion of a cuffed ETT subsequently received tracheostomies for the primary purpose of long-term mechanical ventilation unrelated to any problem with the upper airway. We conclude that cuffed endotracheal intubation is not associated with an increased risk of postextubation stridor or significant long-term sequelae. (J PEDIATR 1994;125:57-62)

Section snippets

METHODS

We collected data prospectively during a 7-month period from July 1988 to February 1989 for all patients who had ETTs inserted during their admission to the PICU at Children's Hospital of Los Angeles (CHLA). Our multidisciplinary PICU is a large tertiary care center with approximately 1400 admissions per year; approximately 50% are surgical patients. The study was approved by the hospital's clinical investigation committee and informed consent was not mandated. All patients were followed,

RESULTS

A total of 243 patients had 282 intubations during the study period. Of these, 80% of all intubations were performed at CHLA; the remainder occurred at the referring hospitals. Table I describes the patient characteristics of the ETT study groups; only the first intubation record per patient was used. Of the 243 patients, 123 (49%) had a cuffed ETT. Patients who received a cuffed ETT were older (mean age, 8.08 vs 2.53 years; p ≤0.001) and intubation was longer (6.1 vs 3.7 days; p = 0.01) than

DISCUSSION

The incidence of postextubation stridor has been reported to range from 1% to 6%.10, 12 However, these reports have been limited to studies of short-term operative intubations and did not include patients with the wide spectrum of diagnoses or prolonged periods of intubation and ventilation as practiced in modern PICUs. In a previous study from our PICU,10 we found the incidence of postextubation stridor to be 25%-higher than previously reported. However, our previous study was limited to

References (20)

There are more references available in the full text version of this article.

Cited by (208)

  • Intraoperative management of the neonate

    2022, Goldsmith's Assisted Ventilation of the Neonate: An Evidence-Based Approach to Newborn Respiratory Care, Seventh Edition
  • Management of the child's airway under anaesthesia: The French guidelines

    2019, Anaesthesia Critical Care and Pain Medicine
  • Pediatric Equipment

    2019, A Practice of Anesthesia for Infants and Children
  • Elevated endotracheal tube cuff pressure in the pediatric emergency department

    2018, International Journal of Pediatric Otorhinolaryngology
View all citing articles on Scopus

From the Division of Pediatric Intensive Care, Children's Hospital of Los Angeles, University of Southern California School of Medicine, Los Angeles

☆☆

Reprint requests: Timothy Deakers, MD, PhD, PICU Administration, Children's Hospital of Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027.

0022-3476/94/$3.00 + 0 9/20/55229

View full text