Microcuff Pediatric Endotracheal Tubes: Evaluation of Cuff Sealing Pressure, Fiber-optic Assessment of Tube Tip, and Cuff Position by Ultrasonography

BACKGROUND: Use of uncuffed tubes causes lots of morbidity, and there is a surge in the use of microcuff pediatric endotracheal tubes. These tubes are not evaluated in the Indian population. AIMS: The study aimed to evaluate the pediatric microcuff endotracheal tubes in terms of cuff sealing pressure, fiber-optic assessment of tube tip, and cuff position to assess postextubation airway morbidity. SETTINGS AND DESIGN: Study design involves follow-up analytical study. SUBJECTS AND METHODS: Thirty-four children in the age group of 2–12 years were studied. Patients with leak pressure >20 cm H(2)O were exchanged with smaller size tube and excluded. Cuff pressure, fiber-optic assessment of tube tip to carina distance in neutral and flexion, ultrasound assessment of cuff position, and postextubation airway morbidity were assessed. STATISTICAL ANALYSIS USED: Parameters expressed as the median with the interquartile range. Nonparametric data were analyzed using the Wilcoxon signed-rank test. RESULTS: The tracheal leak pressure was <20 cm H(2)O (median 14.5 cm H(2)O) in 30 children. Tube exchange was required in four patients. A complete seal was achieved in 30 patients with cuff pressures ranging from 6 to 8.25 cm of H(2)O (median 8 cm of H(2)O). The median caudal displacement is 0.8 cm (0.47–1.22 cm) with flexion. There was no airway-related morbidity in any of these patients. CONCLUSIONS: The microcuff pediatric endotracheal tubes when used according to the age-based formula had a higher tube exchange rate in our study population. However, in children in whom the tube size was appropriate, the tubes provided good sealing without increasing airway morbidity. Further studies with a larger sample size might be required to confirm the findings.