UMEM Educational Pearls

Category: Pediatrics

Title: Pediatric intubation: Cuffed or uncuffed tubes?

Keywords: Intubation, ETT, cuffed, airway management (PubMed Search)

Posted: 12/21/2018 by Jenny Guyther, MD (Updated: 9/27/2022)
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Historically uncuffed endotracheal tubes were used in children under the age of 8 years due to concerns for tracheal stenosis.  Advances in medicine and monitoring capabilities have resulted in this thinking becoming obsolete.  Research is being conducted that is showing the noninferiority of cuffed tubes compared to uncuffed tubes.  Multiple other studies are looking into the advantages of cuffed tubes compared to uncuffed tubes.

The referenced study is a meta-analysis of 6 studies which compared cuffed to uncuffed endotracheal tubes in pediatrics.  The pooled analysis showed that more patients needed tube changes when they initially had uncuffed tubes placed.  There was no difference in intubation duration, reintubation occurrence, post extubation stridor, or racemic epinephrine use between cuffed and uncuffed tubes.

Bottom line: There is no difference in the complication rate between cuffed and uncuffed endotracheal tubes, but uncuffed endotracheal tubes did need to be changed more frequently.

References

Liang C, Zhang J, Pan G, Li X, Shi T, He W.  Cuffed versus uncuffed endotracheal tubes in pediatrics: a meta-analysis.  Open Med.  2018; 13:366-373.