Current practice and attitudes regarding the perioperative use of cuffed tracheal tubes for pediatric and neonatal tracheal intubation: A survey-based evaluation among Indian anesthesiologists

Abstract

Introduction: the use of cuffed endotracheal tubes (ETTs) in children is debatable. Despite recent literature on the use of cuffed ETT in children, its use is relatively low even in developed world. We conducted this survey to explore the perceptions and patterns of cuffed/uncuffed ETT usage in children, <5 years of age. Materials and Methods: This descriptive cross-sectional survey was done using a specially designed Google Form that was circulated among anesthesiologists of any grade practicing in India. The questionnaire was validated by seven experts on a 4-point scale as per the standardized model of content validity index and those with an index <0.78 were modified. Thereafter, the questionnaire was circulated over a month through WhatsApp and a reminder was sent every week for a month. Results: The total response rate was 55% (99/180) and after excluding the responses of postgraduates, 96 responses were evaluated. The use of pediatric cuffed ETT was similar among institutions. Only 35.5% of the respondents routinely used cuffed tubes regularly. The common reasons for nonusage of cuffed tubes included fear of higher resistance to flow and risk of subglottic injury. Those anesthesiologists who were performing higher pediatric cases were more inclined to use a cuffed ETT. Endotracheal cuff pressure was monitored routinely by 40% of the respondents who used cuffed tube. Conclusion: Anesthesiologists practicing pediatric anesthesia are more likely to choose cuffed ETT in children aged <5 years. Safety norms such as cuff pressure monitoring are not being followed routinely when these tubes are used.