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The use of cuffed tracheal tubes for paediatric tracheal intubation, a survey of specialist practice in the United Kingdom

Flynn, P. E.*; Black, A. E.; Mitchell, V.

European Journal of Anaesthesiology (EJA): August 2008 - Volume 25 - Issue 8 - p 685–688
doi: 10.1017/S0265021508003839
Original Article

Background and objective For more than 50 yr, uncuffed tracheal tubes have been the gold standard for intubation in children under the age of 8 yr. However, recently there has been interest in the use of cuffed tubes in paediatric practice. This survey aimed to benchmark UK practice with regard to tracheal intubation within specialist paediatric centres, exploring current cuffed tracheal tube use in children.

Methods A questionnaire was e-mailed to the paediatric intensive care unit and anaesthetic department clinical leads in all UK specialist paediatric hospitals with a paediatric intensive care unit (n = 30). Information was requested on the use of tracheal tubes across all paediatric age groups, as well as the reasons for non-use and the incidence of complications attributed to cuffed tubes.

Results A total of 20 paediatric intensive care unit and 15 anaesthetic questionnaires were returned, equating to a response rate of 67% and 50%, respectively. Only 5% of the paediatric intensive care unit and 7% of the anaesthetic respondents routinely use a cuffed tube in children under the age of 8 yr. The commonest reason cited in both groups for non-cuff use was that there is minimal benefit to be gained over using an uncuffed tracheal tube. The most frequent specific indication for use of a cuffed tube was a reduced lung compliance (60% respondents both groups). In all, 45% of the paediatric intensive care unit respondents and 100% of the anaesthetists reported that they did not routinely monitor the intracuff pressure when using a cuffed tube. The incidence of observed complications attributed to the use of cuffed tubes was far higher amongst paediatric intensive care unit consultants (65% vs. 7% anaesthetists); however, the majority in both groups stated that such complications were no more common than when using an uncuffed tube (60% paediatric intensive care unit and 53% anaesthetists).

Conclusion Cuffed tracheal tubes are rarely routinely used in children, particularly in the under 8 yr age group, in specialist paediatric centres in the UK. When used, it is predominantly for a specific indication, and the monitoring of intracuff pressure is not routine. Current expert consensus is that complications are equally as common when using a cuffed as an uncuffed tube.

*Royal Marsden Hospital, Department of Anaesthesia, London, UK

Great Ormond Street Hospital for Children, Department of Anaesthesia, London, UK

University College Hospital, Department of Anaesthesia, London, UK

Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK. E-mail:; Tel: +44 20 7808 2727; Fax: +44 20 7352 975

Accepted for publication 24 January 2008

First published online 13 March 2008

© 2008 European Society of Anaesthesiology