Abstract
The use of uncuffed endotracheal tubes (ETT) in patients younger than 8 years old has been in practice for the last 60 years. In the last decade, there has been a change in clinical practice with a transition to cuffed ETT use, and there continues to be debate between cuffed vs uncuffed ETT use. This narrative review article aims to review the current literature on the topic and highlight some key points in the argument of cuffed vs uncuffed ETT use in pediatric patients. Cuffed ETTs are increasingly being used with several studies over the last 20 years demonstrating its benefits. Studies have claimed cuffed ETT has a clinical, environmental, and economical benefit over uncuffed ETT. Despite shortcomings of various studies and no definitive conclusion of a superior type of endotracheal tube, cuffed ETTs are here to stay in the world of anesthesia.
Highlights
The use of uncuffed endotracheal tubes (ETT) in patients younger than 8 years old has been in practice for the last 60 years
Traditional teaching was to use appropriately sized uncuffed ETT in children less than 8 years old in order to maximize the internal diameter of the tube and avoid mucosal damage by the cuff
With larger diameter endotracheal tubes, there is less airway resistance and less difficulty with suctioning. This traditional teaching was based on anatomical differences in the pediatric airway which suggested that the pediatric larynx was funnel-shaped with the narrowest part at the cricoid ring
Summary
The use of uncuffed endotracheal tubes (ETT) in patients younger than 8 years old has been in practice for the last 60 years. This was based on studies of pediatric cadaveric specimens which concluded that the airway had a funnel shape with the narrowest part at the cricoid cartilage. There continues to be a debate between cuffed vs uncuffed ETT use due in part to lack of research [2] This narrative review article aims to review the current literature on the topic and highlight some key points in the argument of cuffed vs uncuffed ETT use in pediatric patients. We included 16 articles, which include 3 editorials, 5 review articles, 2 prospective, 3 retrospective, and 3 randomized controlled trials
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