Cuffed Endotracheal Tubes in Infants and Children

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Background. Over the past 5 to 10 years, there has been a change in the clinical practice of pediatric anesthesiology with a transition to the use of cuffed instead of uncuffed endotracheal tubes (ETTs) in infants and children. When such tubes are used in clinical practice, it is imperative to ensure that the intracuff pressure is ≤30 cm H2O. To date, there are limited data regarding techniques to ensure this practice. Methods. Following endotracheal intubation with a cuffed ETT, a stethoscope was placed in the sternal notch and continuous positive airway pressure of 20 to 25 cm H2O held. The fresh gas flow was increased as needed to achieve a gradual rise of the airway pressure. Using a syringe, air was added to the cuff until no air escape or leak was heard. The intracuff pressure was checked using a handheld manometer (Posey Cufflator Endotracheal Tube Inflator and Manometer, JT Posey Company, Arcadia, CA). Results. The cohort for the study included 200 patients ranging in age from 6 months to 18 years. In 5 patients (2.5%), there was no audible air leak noted following endotracheal inflation at a continuous positive airway pressure of 20 to 25 cm H2O. In these patients, the ETT was removed and the trachea was intubated with a 0.5-mm size smaller ETT. In the entire cohort of 200 patients, the intracuff pressure was 21 ± 4 cm H2O. The intracuff pressure was ≥30 cm H2O in 1 of 200 patients (0.5%). Conclusions. The current study demonstrates a simple, bedside maneuver that requires no additional equipment and is effective at ensuring a safe intracuff pressure in virtually all patients.