Cuffed vs non‐cuffed endotracheal tubes for pediatric anesthesia

Abstract

The physician undertaking pediatric anesthesia or management of the critically ill child in the pediatric intensive care unit (PICU) has great potential to cause harm to the child. Over many years, routine management of the pediatric airway has become a relatively safe undertaking and this has been achieved through the worldwide development of the speciality of pediatric anesthesia and intensive care. Any future development needs to acknowledge the large body of developmental work from past that has provided reproducible safe practice. Change must not be for change itself, and at the forefront of our practice must be the desire to provide optimized care that is evidence-based as far as possible. New techniques should be evaluated and adopted only if there is substantial evidence that innovation will be beneficial in the widest sense. This includes not only direct patient benefit but also the wider medicoeconomic arguments. The ‘pro and con’ for the direct medical benefits of cuffed vs uncuffed tubes in children remain finely poised, but the medicoeconomic arguments are irrifutable: cuffed tubes remain many times more expensive than uncuffed tubes and are likely remain so. On this basis alone it can be hard to justify the routine use of the cuffed tube provided equipoise between the two techniques remain. In contrast, on an individual basis there may be strong arguments in favor of selecting a cuffed tube provided there is justification. While enthusiasts of the cuffed tube continue to promote their potential benefits, the majority of pediatric anesthetists worldwide continue to safely use the uncuffed tube on a daily basis and find it hard to justify the large extra costs needed to change their practice when the benefits remain largely unproven. In this, the first in a new series of pro– con debates in Paediatric Anaesthesia we will examine the arguments for and against their use from the perspective of two expert views, with the goal that this will help the reader make up their own mind of whether to reconsider their current practice.