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Microcuff pediatric endotracheal tubes: Evaluation of cuff sealing pressure, fiber-optic assessment of tube tip, and cuff position by ultrasonography


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

Correspondence Address:
Sandeep Kumar Mishra,
Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aer.AER_97_19

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.


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    -  Ramachandran S
    -  Mishra SK
    -  Balachander H
    -  Bidkar PU
    -  Velayudhan S
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