We thank Galante and Caruselli for their comments concerning our editorial1
on the disadvantages of continuing to use uncuffed endotracheal tubes in the pediatric population. In addition to the reasons we discussed, Galante and Caruselli provide insights into the unique anatomical aspects of the pediatric trachea and thus, provide additional reasons to support the abandonment of uncuffed endotracheal tubes in pediatric patients. They also point out that the shape of the trachea may change during the course of a general anesthetic, and this change can only worsen the effects of an uncuffed endotracheal tube on the surface of the tracheal mucosa. However, we believe that the most important clinical consequences of the consistent use of cuffed endotracheal tubes will be evident in chronically intubated newborns, who seem to bear the brunt of ventilation-associated tracheal damage. An additional consideration for the smallest infants, who comprise the most likely population to require prolonged intubation, is the lack of availability of a size 2.5 cuffed tube. Endotracheal tubes with such small diameters are prone to plugging from secretions, and do not suction easily. In these infants, an uncuffed 3.0-sized tube may be the best available option for prolonged intubation in this vulnerable infant population.
Ronald S. Litman, D.O.
Lynne G. Maxwell, M.D.
*Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. firstname.lastname@example.org