89424
document
Comparison of cuffed and uncuffed endotracheal tubes in young children during general anesthesia . BACKGROUND Uncuffed endotracheal tubes are routinely used in young children . This study tests a formula for selecting appropriately sized cuffed endotracheal tubes and compares the use of cuffed versus uncuffed endotracheal tubes for patients whose lungs are mechanically ventilated during anesthesia . METHODS Full-term newborns and children ( n = 488 ) through 8 yr of age who required general anesthesia and tracheal intubation were assigned randomly to receive either a cuffed tube sized by a new formula [ size ( mm internal diameter ) = ( age/4 ) + 3 ] , or an uncuffed tube sized by the modified Cole 's formula [ size ( mm internal diameter ) = ( age/4 ) + 4 ] . The number of intubations required to achieve an appropriately sized tube , the need to use more than 21.min-1 fresh gas flow , the concentration of nitrous oxide in the operating room , and the incidence of croup were compared . RESULTS Cuffed tubes selected by our formula were appropriate for 99 % of patients . Uncuffed tubes selected by Cole 's formula were appropriate for 77 % of patients ( P < 0.001 ) . The lungs of patients with cuffed tubes were adequately ventilated with 2 1.min-1 fresh gas flow , whereas 11 % of those with uncuffed tubes needed greater fresh gas flow ( P < 0.001 ) . Ambient nitrous oxide concentration exceeded 25 parts per million in 37 % of cases with uncuffed tubes and in 0 % of cases with cuffed tubes ( P < 0.001 ) . Three patients in each group were treated for croup symptoms ( 1.2 % cuffed ; 1.3 % uncuffed ) . CONCLUSIONS Our formula for cuffed tube selection is appropriate for young children . Advantages of cuffed endotracheal tubes include avoidance of repeated laryngoscopy , use of low fresh gas flow , and reduction of the concentration of anesthetics detectable in the operating room . We conclude that cuffed endotracheal tubes may be used routinely during controlled ventilation in full-term newborns and children during anesthesia .
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Intervention_Physical
cuffed and uncuffed endotracheal tubes
89426
Intervention_Physical
Uncuffed endotracheal tubes
89427
Intervention_Physical
cuffed versus uncuffed endotracheal tubes
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Intervention_Physical
cuffed tube sized by a new formula
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Intervention_Physical
uncuffed tube sized by the modified Cole 's formula
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Intervention_Physical
Cuffed tubes
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Intervention_Physical
Uncuffed tubes
89432
Intervention_Physical
cuffed endotracheal tubes
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Intervention_Physical
cuffed endotracheal tubes
89434
Outcome_Other
number of intubations required to achieve an appropriately sized tube
89435
Outcome_Other
need to use more than 21.min-1 fresh gas flow
89436
Outcome_Physical
concentration of nitrous oxide in the operating room
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Outcome_Physical
incidence of croup
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Outcome_Physical
lungs
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Outcome_Other
adequately ventilated
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Outcome_Other
Ambient nitrous oxide concentration
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Outcome_Physical
croup symptoms
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Outcome_Other
Advantages
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Outcome_Other
avoidance of repeated laryngoscopy
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Outcome_Other
use of low fresh gas flow
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Outcome_Other
reduction of the concentration of anesthetics detectable in the operating room
89446
Participant_Age
young children
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Participant_Condition
anesthesia .
89448
Participant_Age
young children
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Participant_Age
Full-term newborns and children
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Participant_Sample-size
488
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Participant_Condition
)
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Participant_Condition
general anesthesia and tracheal intubation
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Participant_Age
young children
89454
Participant_Age
full-term newborns and children
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Participant_Condition
anesthesia