Cuffed versus uncuffed endotracheal tubes in children: a meta-analysis.

Abstract

Cuffed endotracheal tubes (ETTs) have increasingly been used in small children. However, the use of cuffed ETTs in small children is still controversial. The goal of this meta-analysis is to assess the current evidence regarding the postextubation morbidity and tracheal tube (TT) exchange rate of cuffed ETTs compared to uncuffed ETTs in children. A systematic literature search in PubMed, Web of Science, Embase, and Cochrane Central Register of Controlled Trials up to November 2014 was conducted to identify randomized controlled trials (RCTs) and prospective cohort studies that compared the use of cuffed and uncuffed ETTs in children. The primary outcome was the incidence of postextubation stridor and the second outcomes were the TT exchange rate, need for re-intubation, and duration of tracheal intubation. All pooled data were estimated using random effects meta-analysis. Two RCTs and two prospective cohort studies including 3782 patients, in which 1979 patients for cuffed tubes and 1803 patients for uncuffed tubes, were included in our analysis. We found that the use of cuffed ETTs did not significantly increase the incidence of postextubation stridor (RR=0.88; 95% CI 0.67-1.16, p=0.36), and the TT exchange rate was lower in patients receiving cuffed tubes intubation (RR, 0.07; 95% CI 0.05-0.10, p<0.00001). The need for re-intubation following planned extubations and duration of tracheal intubation did not differ significantly between the cuffed tube group and the uncuffed tube group. Our study demonstrates that cuffed ETTs reduce the need for TT exchanges and do not increase the risk for postextubation stridor compared with uncuffed ETTs.