Cuffed endotracheal tubes in pediatric intensive care☆,☆☆,★
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)
The risk of aspiration in presence of cuffed endotracheal tubes
Br J Anaesth
(1972)- et al.
Analysis of problems related to cuffs on endotracheal tubes
Chest
(1972) - et al.
Complication and consequences of endotracheal intubation and tracheostomy
Am J Med
(1981) - et al.
Dexamethasone in the prevention of postextubation stridor in children
J PEDIATR
(1991) - et al.
A prospective randomized double-blind study to evaluate the effect of dexamethasone in acute laryngotracheitis
J PEDIATR
(1989) Mechanisms of laryngotracheal injury following prolonged tracheal intubation
Chest
(1989)- et al.
Cardiopulmonary resuscitation in infants and children
Anesthesia equipment in pediatrics
Histopathology of endotracheal intubation
Arch Pathol
(1969)
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 EditionManagement of the child's airway under anaesthesia: The French guidelines
2019, Anaesthesia Critical Care and Pain MedicineUltrasound-guided lung sliding sign to confirm optimal depth of tracheal tube insertion in young children
2019, British Journal of AnaesthesiaPediatric Equipment
2019, A Practice of Anesthesia for Infants and ChildrenElevated endotracheal tube cuff pressure in the pediatric emergency department
2018, International Journal of Pediatric OtorhinolaryngologyAccuracy of stridor-based diagnosis of post-intubation subglottic stenosis in pediatric patients
2020, Jornal de Pediatria
- ☆
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