Articles: tracheal-tube.
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Why should I read this?
The cuffed vs non-cuffed ETT debate for children and neonates is largely settled, demonstrating the superiority of modern cuffed tubes over their historical, uncuffed forbears. Nevertheless, despite reliable evidence to the contrary, many general anaesthetists still prefer uncuffed tubes for children.
Give me the quick overview
Shah & Carlisle explore the accumulated evidence supporting the shift to cuffed endotracheal tubes by paediatric anaesthetists, both in neonates and older children.
They challenge historical airway anatomy & physiology myths that once encouraged the use of uncuffed ETTs in children, and the questionable reliability of the widely-used Cole formula for tube size prediction (size = age/4 + 4; correct in only 50-75%).
The development of Weiss et al.'s Microcuff™ tube represents a watershed moment in addressing concerns of paediatric airway trauma from cuffed ETTs, resulting in improved ETT function without any increase in stridor.
More recently, Chamber's 2018 RCT compared cuffed and uncuffed ETTs in children undergoing elective general anaesthesia, and found that cuffed tubes improved ventilation and reduced short-term post-operative respiratory complications, in addition to decreasing tube changes.
Addressing concern for increased work-of-breathing and higher inspiratory pressures when using a 0.5 mm smaller ID tube, Shah & Carlisle note Thomas et al.'s 2018 laboratory study showing any such effect is easily compensated for with pressure support and automatic tube compensation.
Similarly, the authors also note that there has been no demonstrated evidence of an increased incidence of subglottic stenosis in children using cuffed ETTs.
Finally, Shah & Carlisle report on their updated meta-analysis, showing that cuffed tracheal tubes in children result in fewer tube changes and less sore throat, but no difference in risk of laryngospasm.
Finally word
Using a modern, Microcuff™ or equivalent cuffed ETT that is 0.5 mm smaller in size than an equivalent uncuffed tube, offers functional, ventilation and safety benefits.
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Randomized Controlled Trial Comparative Study
Ultrasound-guided lung sliding sign to confirm optimal depth of tracheal tube insertion in young children.
The tip of the tracheal tube should lie at the mid-tracheal level after tracheal intubation in paediatric patients. Auscultation does not guarantee optimal positioning of the tracheal tube. We compared auscultation and the ultrasound-guided lung sliding sign to confirm optimal positioning of the tracheal tube in paediatric patients. ⋯ KCT 0003015.
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Randomized Controlled Trial
Effect of neck extension on the advancement of tracheal tubes from the nasal cavity to the oropharynx in nasotracheal intubation: a randomized controlled trial.
Clinicians sometimes encounter resistance in advancing a tracheal tube, which is inserted via a nostril, from the nasal cavity into the oropharynx during nasotracheal intubation. The purpose of this study was to investigate the effect of neck extension on the advancement of tracheal tubes from the nasal cavity into the oropharynx during nasotracheal intubation. ⋯ Neck extension during tube advancement from the nasal cavity to the oropharynx before laryngoscopy could be helpful in nasotracheal intubation.
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In-vitro analysis of a novel 'add-on' silicone cuff to improve sealing properties of tracheal tubes.
Leakage of colonised oropharyngeal secretions across the tracheal tube cuff may cause iatrogenic pulmonary infection. We studied a novel 'add-on' cuff, which can be inserted over an existing tracheal tube and advanced into the subglottic region. The physical properties of the novel silicone cuff (BronchoGuard, Ciel Medical, USA) were evaluated in comparison with the Hi-Lo® tracheal tube. ⋯ Although massive leak was found when the novel cuff transmitted pressures ≤ 20 cmH2 O against the trachea, leakage was avoided with pressures ≥ 25 cmH2 O, owing to optimal contact between the cuff and the tracheal wall. In contrast, the standard cuff consistently leaked irrespective of the pressure. We conclude that the novel cuff has advantageous properties that warrant clinical corroboration.