Cuffed tracheal tubes in children – things have changed

Abstract

Whether cuffed tubes should be routinely used in infants and small children has been extensively discussed in the past. However, opinions and recommendations were not based on scientific evidence but rather on empiricism. The basic function of a tracheal tube is to provide a reliable connection between the patient’s lung and the bag or ventilator. Ideally, this connection should be leak-proof without causing undue pressure to laryngeal or tracheal structures. If this connection is not reasonably tight or sealed, constant minute ventilation, precise respiratory monitoring and capnography, low fresh gas flow and prevention of pulmonary aspiration are not possible. In an emergency situation and in patients with severe lung disease good sealing becomes even more important. Traditional teaching for the last 50 years was that in children under 8‐10 years of age, this sealing should be obtained with an uncuffed tracheal tube that would slip easily through the cricoid and leave some space for an air leak at 25 cm H2O airway pressure. Without any real evidence, cuffed tubes were not considered appropriate for children, in contrast with adults. This teaching was based on the idea that the