Endotracheal Tubes In Infants Research Articles

Incidence of Post-extubation Stridor in Infants With Cuffed vs. Uncuffed Endotracheal Tube: A Retrospective Cohort Analysis.

BackgroundEndotracheal intubation is a common procedure in Neonatal Intensive Care. While cuffed endotracheal tubes (ETT) are the standard of care in adults and children, their use in infants is controversial. The aim of this study was to compare the incidence of post-extubation stridor between uncuffed and cuffed ETTs in infants. We further evaluated the safety of cuffed ETTs in infants with a bodyweight between 2 and 3 kg and performed baseline analysis on development of subglottic stenosis.MethodsIn this retrospective study, we screened all infants admitted to two NICUs of the Medical University of Vienna between 2012 and 2019.The study cohort was screened twice: In the first screening we selected all infants who underwent the first intubation when attaining a bodyweight >2 kg (but <6 kg) to analyze the incidence of post-extubation stridor and only considered the first intubation of each included infant. Post-extubation stridor was defined as the administration of either epinephrine aerosol or any corticosteroid within 6 h post-extubation. In the second screening we searched for all infants diagnosed with acquired severe subglottic stenosis during the study period regardless their bodyweight and numbers of intubations.ResultsA total of 389 infants received at least one intubation during the study period. After excluding infants who underwent the first intubation below a bodyweight of 2 kg, 271 infants remained for final analysis with an average gestational age of 38.7 weeks at the time of intubation. Among those, 92 (33.9%) were intubated with a cuffed and 179 (66.1%) with an uncuffed ETT. Seven infants (2.6%) developed a clinically significant stridor: five of those were intubated with a cuffed and two with an uncuffed ETT (71.4 vs. 28.6%, p = 0.053). All of them had a bodyweight >3 kg at the time of intubation. Infants who developed subglottic stenosis were more often intubated with an uncuffed ETT.ConclusionIn this study, no difference in the incidence of post-extubation stridor between cuffed and uncuffed ETTs in infants with a bodyweight from 2 to 6 kg could be found. The use of uncuffed ETTs does not exhibit higher risk for the acquired subglottic stenosis in this cohort.

Abstract No.: ABS1770: Cuffed versus uncuffed endotracheal tubes in infants undergoing elective surgery in prone position:peritubal leak at standardised ventilator settings

Background & Aims:The purpose of this study was to compare peritubal leak in cuffed and uncuffed tubes in infants at standardised ventilatorsettings. Secondary objective was to see incidence of accidental extubation and postoperative respiratory complications such as stridor and sore throat.Methods:With ethics committee approval, a prospective,randomised,clinical study was conducted. Patients aged between birth to 1 year, American Society of Anesthesiologists ASA grade I,II and III, requiring general anaesthesia with orotracheal intubation in prone position during elective surgery were included and children with parents not giving consent,children with airway anomaly, laparoscopic surgery, and emergency surgery were excluded. Tracheal tube size was judged as adequate if the leak pressure was 20 cm H2O or less. Tube was exchanged to next larger size if the leak pressure was too high and tube size was exchanged to next smaller size, when cuff pressure exceeded 20 cm H2O.Results:60 infants were studied.In group 1 in which cuffed tube was used, there were no leaks,on the other hand, in group 2,17 out of 30 patients had peritubal leak and tube was exchanged to next larger size uncuffed tube, p value was <0.001. Moreover, the incidenceof accidental extubation, post extubation sore throat and stridor was more in uncuffed group, It was 2/6/6 in uncuffed group and 0/3/4 in cuffed group respectively. Tracheal tube exchange rate was also higher in uncuffed group.Conclusion:We found that in microcuff paediatric endotracheal tube, there is less peritubal leak; selection of cuffed tube with small internal diameter compared to uncuffed tubes implicates a higher chance for adequate fit of the tube at cricoid ring and due to this there is least chance of accidental extubation in the prone position.Peritubal leakGroup I (n=30)Group II (n=30)Total (n=60) No.%No.%No.%Absent30100.01343.34371.7Present00.01756.71728.3

Use of cuffed endotracheal tubes in infants less than 5 kilograms: A retrospective cohort study

BackgroundImproved understanding of airway anatomy and refinement of equipment have led to the increased use of cuffed endotracheal tubes (ETTs) in infants and children. Despite expanded evidence on the potential advantages of cuffed ETTs in pediatric patients, there remains limited data on their use in infants less than 5 kilograms (kg). The current study retrospectively evaluates the perioperative use of cuffed ETTs in infants weighing 2–5 kg. MethodsThis is a retrospective study from a tertiary care children's hospital involving a 3-year period. Data regarding anesthetic care, airway management, and postoperative course were retrospectively retrieved from the electronic medical record. ResultsThe study cohort included 1162 patients, 1086 of whom had their tracheas intubated with a cuffed ETT and 76 with an uncuffed ETT. Patients were divided into two groups for analysis: 2 to <3 kg and 3 to 5 kg. In both weight groups, cuffed ETTs resulted in a decreased need for more than one laryngoscopy and a change in ETT size with no increase in postoperative airway effects including stridor. ConclusionsThese data provide additional information regarding the efficacy and safety of cuffed ETTs in neonates and infants.

The Perioperative Services Response at a Major Children's Hospital During the Peak of the COVID-19 Pandemic in New York City.

The Perioperative Services Response at a Major Children's Hospital During the Peak of the COVID-19 Pandemic in New York City.

Evaluation of size 3.0 Microcuff endotracheal tube in infants undergoing major surgery under general anaesthesia.

Evaluation of size 3.0 Microcuff endotracheal tube in infants undergoing major surgery under general anaesthesia.

Tracheal Size and Morphology on the Reconstructed CT Imaging.

To characterize the real size and morphology of tracheas in childhood for the optimal selection of endotracheal tube. A retrospective cohort study of pediatric patients who received CT scan of the cervical spine from July 2011 to March 2018. Cross-sectional CT images vertical to trachea were reconstructed and the accurate tracheal diameters were measured. The validity of the traditional age-based formula for predicting the endotracheal tube size was assessed for the best fit to trachea. Tertiary Emergency and Critical Care Center of Kyushu University Hospital. Children, who are 1 month to 15 years old, received CT scan of the cervical spine. None. We enrolled 86 children with median age of 53 months. The cross-sectional shape of pediatric trachea was circular at the cricoid level and elliptical at the infraglottic level. The narrowest part of pediatric trachea was the transverse diameter at the infraglottic level at any age. Significant positive correlation between age and the narrowest diameter was observed. When compared the transverse diameter at the infraglottic level with the outer diameter of endotracheal tubes, uncuffed endotracheal tubes selection based on the traditional age-based formula ran a significant risk of oversized endotracheal intubation until 10 years old compared with cuffed endotracheal tubes selection (60.0% vs 23.8%; p < 0.05). These findings indicate the safety and efficacy of cuffed endotracheal tubes in infants and children and the reconsideration for the airway management in pediatric anesthesia and intensive care.

Abstract P-453: EFFECTS OF ENDOTRACHEAL SUCTIONING IN NEWBORN PRETERM INFANTS WEIGHING BETWEEN 500 AND 1500g

Aims & Objectives: Objective: To observe different ways of implementing the techniques of aspiration of preterm infants and verify factors associated with changes in oxygen saturation, contamination of equipment and heart rate. Methods Methods: An observational, prospective, descriptive study. The aspirations of the endotracheal tube in infants with birth weights between 500 and 1500 grams were observed during two procedures; morning and evening. The associations between the number of professionals performing the technique, shift work and the variables of interest were made by linear mixed effect models. Results Results: We evaluated 32 infants with a mean weight of 942 g and a mean gestational age of 28 weeks, 64 aspiration procedures were followed. During aspiration 61 % of children had hypoxemia. The saturation drops were more related to the aspiration held by a single professional, also when they were made more than three disconnections of the fan and when disconnections occurred beyond fifteen seconds. During the night more contamination events and longer ventilation disconnection occurred. There was no association between changes in heart rate with the variables analyzed. The use of saline during suctioning in less than 1ml volume was associated with significant decreases saturation. Conclusions Conclusions: The aspiration of the endotracheal tube can lead to hypoxemia. To minimize episodes is important that it be performed by two professionals that meet the care disconnecting the system less than 3 times and use less than 15 seconds.

The Effect of Transesophageal Echocardiography Probe Placement on Intracuff Pressure of an Endotracheal Tube in Infants and Children

To evaluate the effects of transesophageal echocardiography (TEE) probe insertion on the endotracheal cuff pressure (CP). Prospective observational study. Single standing, not-for-profit pediatric hospital. A total of 80 pediatric patients (aged 6 days to 18.4 years) who underwent cardiac surgery and intraoperative TEE. None. Following anesthesia induction and endotracheal intubation, the CP was recorded at 4 points: before the insertion of the TEE (P1), at TEE insertion (P2), during TEE examination (P3), and after the probe was advanced into the stomach (P4). Twenty patients were enrolled in each of the following age groups:<1 year of age; 1-4 years of age; 5-8 years of age; and 9-18 years of age. CP was compared between pairs of time points using paired t-tests, and differences in CP over time were compared among age groups using repeated-measures analysis of variance. CP at P1, P2, P3, and P4 was 18.7±11.6, 26.7±14.4, 22.3±12.4, and 20.6±12.6 cmH2O, respectively. Although CP significantly increased from P1 to P2 (p<0.001), there was no significant difference between P1 and P4 (95% CI; -0.3 to 4.1; p = 0.083). There was no significant difference in CP change based on the age of the patient. Following a transient increase in CP with TEE probe insertion, the CP returned to baseline after the tip of the TEE probe was advanced into the stomach. There was no variation among age groups in the magnitude of the CP change during the study.

Cuffed endotracheal tubes in neonates and infants undergoing cardiac surgery are not associated with airway complications

Study ObjectiveTo determine the incidence of postoperative airway complications in infants <5kg in weight undergoing cardiac surgery intubated with Microcuff (Kimberley-Clark, Roswell, GA) endotracheal tubes (ETTs). DesignRetrospective review of infants weighing <5.0 kg with congenital heart disease (CHD) presenting for cardiac surgery. SettingSingle-center, tertiary pediatric cardiac critical care unit at a university hospital. PatientsA total of 208 infants weighing <5 kg underwent cardiac surgery for CHD from 2008 to 2013. InterventionIntubation with Microcuff (Kimberley-Clark) ETTs. Study DesignRetrospective review of infants weighing <5.0 kg with CHD presenting for cardiac surgery to a single-center tertiary care university hospital. Measurements: Perioperative data were collected. Primary outcome was development of tracheal stenosis and/or reintubation for stridor. Stridor was defined as mild (≤2 doses of racemic epinephrine), moderate (>2 doses of racemic epinephrine), or severe (requiring reintubation). Secondary outcomes were variables possibly contributing to postextubation stridor. Infants with a tracheostomy, airway anomalies, and death prior to initial extubation were excluded. Logistic regression analysis was performed to evaluate the association between clinical risk factors and the incidence of postextubation stridor. ResultsA total of 208 infants weighing <5 kg underwent cardiac surgery for CHD from 2008 to 2013; 12 subjects were excluded for death prior to initial extubation. No infant developed tracheal stenosis. The incidence of any stridor was 20.9% (95% confidence interval, 15.8%-27.1%) with severe stridor in 2 cases (1%). Age at surgery, weight, duration of intubation, dexamethasone use, and ETT size were not significantly associated with postextubation stridor. Presence of a comorbidity was significantly associated with stridor (P=.01). ConclusionsMicrocuff ETTs in infants <5.0 kg in weight undergoing cardiac surgery are associated with a low incidence of severe postextubation stridor. Because cuffed ETTs allow for improved control of ventilation/oxygenation and decreased risk of aspiration, they should be considered for use in this high-risk population. Larger studies are needed to confirm these results.

Cuffed endotracheal tubes for neonates and young infants: a comprehensive review

Traditionally, uncuffed endotracheal tubes (ETTs) have been used for artificial ventilation of infants and children. More recently, newer designed high-volume low-pressure (HVLP) cuffed ETTs are being used with increasing frequency...

PO-0684 Effects Of Endotracheal Suctioning In Newborn Preterm Infants Weighing Between 500 And 1500 G

Objective To observe different ways of implementing the techniques of aspiration of preterm infants and verify factors associated with changes in oxygen saturation and contamination of equipment. Methods An observational, prospective, descriptive study. The aspirations of the endotracheal tube in infants with birth weights between 500 and 1500 g were observed during two procedures; morning and evening. Results We evaluated 32 infants with a mean weight of 942 g and a mean gestational age of 28 weeks (64 aspiration procedures). During aspiration 61% of children had hypoxemia. The saturation drops were more related to the aspiration held by a single professional, also when they were made more than three disconnections of the fan and when disconnections occurred beyond fifteen seconds. The pre – oxygenation did not decrease significantly during the procedure hypoxia and preterm – oxygen showed hyperoxia from third minute of recovery. The aspiration held by two professionals joined the adequate pre – oxygenation, decreased number and duration of disconnections ventilation, and less contamination of materials. The use of saline during suctioning in less than 1 ml volume was associated with significant decreases saturation. Conclusions The aspiration of the endotracheal tube can lead to hypoxemia. To minimise episodes is important that it be performed by two professionals that meet the care disconnecting the system less than 3 times and use less than 15 seconds. Also pre-oxygenation should be done with caution and the use of less than 1 ml volume of saline solution leads to negative consequences for the patient.

Cuffed endotracheal tubes in infants and children: A technique to continuously measure the intracuff pressure

ObjectivesVarious devices have been used to measure the intracuff pressure (CP) of an endotracheal tube at the time of inflation; however, no device has found widespread acceptance for the continuous monitoring of CP. We devised a simple method to continuously measure the CP using an invasive pressure monitoring setup (IPMS), which is used routinely in the operating room to monitor arterial or central venous pressures. The accuracy of the device was compared to those obtained from a commercially available and clinically used manometer (MM). MethodsSize 4.0, 5.0 and 6.0mm ID cETTs were placed into one of 3 sizes of polyvinylchloride (PVC) tubes. The cuff of the cETT was inflated after inserting the cETT into the PVC pipes. After inflation, the CP was simultaneously checked using the MM and the IPMS. A total of 100 simultaneous (IPMS and MM) readings were obtained from each of the 3 sizes of cETT with the intracuff pressure randomly varying between 10 and 40cmH2O. Statistical analysis included a Bland–Altman comparison to determine the bias, mean, and 95% levels of agreement (LOA), and a linear regression analysis. ResultsLinear regression analysis demonstrated an R2 value of 0.988, 0.9899, and 0.9879 when comparing the pressure from the IPMS and MM from the 4.0, 5.0 and 6.0mm cETT, respectively. ConclusionsA standard IPMS can be used to continuously monitor intracuff pressure with the use of a cETT. Although various techniques can be used safely to avoid hyperinflation of the cuff, they provide only an instantaneous measure of the CP. The current technique allows for continuous monitoring of CP during prolonged cases or in other clinical scenarios when such monitoring is required.

Can the Intracuff Pressure Be Estimated by Palpation of the Pilot Balloon?

Background. Over the past 5 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 in infants and children. However, there has been limited attention to techniques to ensure a safe intracuff pressure. We sought to determine the accuracy of estimating endotracheal tube intracuff pressure by palpation of the pilot balloon by anesthesiologists, anesthesia residents, pediatric anesthesia fellows, certified nurse anesthetists, and student nurse anesthetists. Methods. A tracheal simulation model was constructed with 3 different diameters of polyvinylchloride tubing. Three different-sized endotracheal tubes (4.0, 5.0, and 6.0 mm) were then placed into the tubes and the cuffs inflated to various pressures. Each participant was given 3 different scenarios of cuff pressure for each endotracheal tube size for a total of 9 scenarios per practitioner. By feeling the pilot balloon, the anesthesia provider was asked to estimate whether the cuff pressure was greater than 30 cm H2O, 20 to 30 cm H2O, or less than 20 cm H2O. The cuff pressure was then measured using a manometer to determine whether they had correctly estimated the intracuff pressure. Results. A total of 106 anesthesia providers participated in the study. Participants were able to estimate the correct intracuff pressure with palpation of the pilot balloon 45% of the time. In the remaining cases, the intracuff pressure was overestimated 29.4% of the time and underestimated 25.7% of the time. The intracuff pressure was correctly identified 44.4% of the time by attending physicians, 55.67% of the time by anesthesia residents or fellows, 50.6% of the time by certified nurse anesthetists, and 38.4% of the time by student nurse anesthetists. Conclusion. Participants from all the groups were unable to reliably estimate endotracheal intracuff pressure from palpation of the pilot balloon. Given the potential injury from excessive intracuff pressures, other techniques are necessary to ensure that excessive pressures are not present.

Cuffed Endotracheal Tubes in Infants and Children

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.

Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome.

Clinical trials have confirmed that surfactant therapy is effective in improving the immediate need for respiratory support and the clinical outcome of premature newborns. Trials have studied a wide variety of surfactant preparations used either to prevent (prophylactic or delivery room administration) or treat (selective or rescue administration) respiratory distress syndrome (RDS). Using either treatment strategy, significant reductions in the incidence of pneumothorax, as well as significant improvement in survival, have been noted. It is unclear whether there are any advantages to treating infants with respiratory insufficiency earlier in the course of RDS. To compare the effects of early versus delayed selective surfactant therapy for newborns intubated for respiratory distress within the first two hours of life. Planned subgroup analyses included separate comparisons for studies utilizing natural surfactant extract and synthetic surfactant. We searched the Oxford Database of Perinatal Trials, MEDLINE (MeSH terms: pulmonary surfactant; text word: early; limits: age, newborn: publication type, clinical trial), PubMed, abstracts, conference and symposia proceedings, expert informants, and journal handsearching in the English language. For the updated search in April 2012 we searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, 2012, Issue 1) and PubMed (January 1997 to April 2012). Randomized and quasi-randomized controlled clinical trials comparing early selective surfactant administration (surfactant administration via the endotracheal tube in infants intubated for respiratory distress, not specifically for surfactant dosage) within the first two hours of life versus delayed selective surfactant administration to infants with established RDS were considered for review. Data regarding clinical outcomes were excerpted from the reports of the clinical trials by the review authors. Subgroup analyses were performed based on type of surfactant preparation, gestational age, and exposure to prenatal steroids. Data analysis was performed in accordance with the standards of the Cochrane Neonatal Review Group. Six randomized controlled trials met selection criteria. Two of the trials utilized synthetic surfactant (Exosurf Neonatal) and four utilized animal-derived surfactant preparations.The meta-analyses demonstrate significant reductions in the risk of neonatal mortality (typical risk ratio (RR) 0.84; 95% confidence interval (CI) 0.74 to 0.95; typical risk difference (RD) -0.04; 95% CI -0.06 to -0.01; 6 studies; 3577 infants), chronic lung disease (typical RR 0.69; 95% CI 0.55 to 0.86; typical RD -0.04; 95% CI -0.06 to -0.01; 3 studies; 3041 infants), and chronic lung disease or death at 36 weeks (typical RR 0.83; 95% CI 0.75 to 0.91; typical RD -0.06; 95% CI -0.09 to -0.03; 3 studies; 3050 infants) associated with early treatment of intubated infants with RDS.Intubated infants randomized to early selective surfactant administration also demonstrated a decreased risk of acute lung injury including a decreased risk of pneumothorax (typical RR 0.69; 95% CI 0.59 to 0.82; typical RD -0.05; 95% CI -0.08 to -0.03; 5 studies; 3545 infants), pulmonary interstitial emphysema (typical RR 0.60; 95% CI 0.41 to 0.89; typical RD -0.06; 95% CI -0.10 to -0.02; 3 studies; 780 infants), and overall air leak syndromes (typical RR 0.61; 95% CI 0.48 to 0.78; typical RD -0.18; 95% CI -0.26 to -0.09; 2 studies; 463 infants).A trend toward risk reduction for bronchopulmonary dysplasia (BPD) or death at 28 days was also evident (typical RR 0.94; 95% CI 0.88 to 1.00; typical RD -0.04; 95% CI -0.07 to -0.00; 3 studies; 3039 infants). No differences in other complications of RDS or prematurity were noted.Only two studies reported on infants under 30 weeks' gestation. Decreased risk of neonatal mortality and chronic lung disease or death at 36 weeks' postmenstrual age was noted. Early selective surfactant administration given to infants with RDS requiring assisted ventilation leads to a decreased risk of acute pulmonary injury (decreased risk of pneumothorax and pulmonary interstitial emphysema) and a decreased risk of neonatal mortality and chronic lung disease compared to delaying treatment of such infants until they develop worsening RDS.

Cuffed endotracheal tubes in infants and children: Should we routinely measure the cuff pressure?

Objective Over the past 5 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 in infants and children. However, there are few studies evaluating the current practices of inflation of these cuffs and the intracuff pressures. Method There was no change dictated in clinical practice for these patients. During the first 30 min of the case, the pressure in the cuff was measured using a hand held manometer. Additional data collected included the patient's demographic data (age, weight, and gender), the size of the ETT, whether nitrous oxide was in use, whether the patient was breathing spontaneously or undergoing positive pressure ventilation, and the type of anesthesia provider (resident, fellow, CRNA or SRNA). Results The cohort for the study included 200 patients ranging in age from 1 month to 17 years and in weight from 3.5 to 99.1 kg. The average cuff pressure was 23 ± 22 cmH 2O in the total cohort of 200 patients. The cuff pressure was ≥30 cmH 2O in 47 of the 200 patients (23.5%). The average cuff pressure was significantly higher in patients who were 8 years of age or greater compared to younger patients. Additionally, there were significantly more patients with a cuff pressure ≥30 cmH 2O in the ≥8 year old age group. Although no difference in the mean cuff pressure was noted when comparing staff anesthesia providers (pediatric anesthesiologist or CRNA) versus trainees (SRNA, anesthesiology resident, medical student or pediatric anesthesiology fellow), the incidence of significantly excessive cuff pressures (≥60 cmH 2O) was higher in the trainee group versus the faculty group (12 of 99 versus 2 of 101, p < 0.0001). Conclusions Using current clinical practice to inflate the cuff, a significant percentage of pediatric patients have an intracuff pressure greater than the generally recommended upper limit of 30 cmH 2O.

Endotracheal tubes in paediatric anaesthesia: the cuffed versus uncuffed debate

The paediatric airway demands respect, and appropriate and safe management of this delicate structure is of utmost importance. With development of polyvinyl chloride (PVC) in the 1960s, uncuffed endotracheal tubes (ETTs) replaced tracheostomies for long-term intubation and ventilation in the intensive care unit (ICU). Since then, uncuffed ETTs have traditionally been used in infants and children under the age of eight (or even ten) years for both short- and long-term intubation in theatre and ICU. Cuffed ETTs were not considered appropriate in this age group, and until fairly recently many manufacturers of ETTs did not produce cuffed sizes smaller than a 5 mm internal diameter (ID). However, debate in the literature over the last decade questions this teaching, some saying that the routine use of uncuffed ETTs in infants and children is not based on scientific evidence. It is clear that the strongly emerging role of cuffed ETTs in the paediatric population has come to the fore.

Optimising placement of endotracheal tubes in infants referred for neonatal transfer

10 (3–63) 19 (10–47) 0.011 About 2 weeks post randomisation, 94% of infants had successfully weaned in the ‘pressure’ group compared with 67% in the ‘time off’ group. A week later, 97% in the pressure group had weaned compared with 81% in the time off group. A Kaplan–Meier graph on ‘time to wean’ for all patients in both groups was drawn and generated a log rank test with a highly significant p value of <0.001 for differences in median time to wean. Infants weaned via pressure reduction faster [pressure= 36 h (95% CI: 31.3 to 50.7) vs. time off=352 h (95% CI: 209.5 to 494.5)]. Conclusion: For VLBW infants, the gradual reduction in nCPAP pressure may facilitate more rapid respiratory weaning compared with periods of increasing time spent off nCPAP. Reference [1] Sreenan C, Lemke RP, Hudson-Mason A, Osiovich H. High-flow nasal cannula in the management of apnea of prematurity: a comparison with conventional nasal continuous positive airway pressure. Pediatrics 2001;107:

The use of cuffed endotracheal tubes in infants and small children

The use of endotracheal tubes with a cuff is controversial in infants and small children. Often anaesthetists advocate extreme opinions and whereas some propagate the use of cuffed tubes in all cases without restriction, others condemn their use in infants and small children under all circumstances. In this article, the discussion concerning the use of cuffed endotracheal tubes in infants and small children is based on current data and arguments. Relevant facts about the anatomy of the upper airway are reviewed and tube products that are currently available, their correct use in infants as well as the inherent potential advantages and disadvantages related to their use are discussed. The overall incidence of iatrogenic damage after short lasting endotracheal intubation is low. However, acquired subglottic stenosis might represent a severe long-lasting complication. Regardless as to whether tubes with or without cuffs are used, a disproportion between the outer diameter of the tube and the inner diameter of the nonexpandable cricoid ring is the main reason for the genesis of this lesion. A continuous monitoring of the cuff pressure is recommended when using cuffed endotracheal tubes in this age group.

A Use of Telescope of Rigid Type Bronchoscope Through Endotracheal Tube in Infants

Yahagi, Naoki MD; Kumon, Keiji MD; Sugimoto, Hisashi MD; Inagaki, Yoshimi MD Author Information