A&A Case Reports 最新文献_第6页

Cuffed Endotracheal Tubes in Children: Size Does Matter! 儿童袖口气管插管:尺寸很重要!

A&A Case Reports Pub Date : 2017-01-20 DOI: 10.1213/XAA.0000000000000448

M. Weiss

{"title":"Cuffed Endotracheal Tubes in Children: Size Does Matter!","authors":"M. Weiss","doi":"10.1213/XAA.0000000000000448","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000448","url":null,"abstract":"March 15, 2017 • Volume 8 • Number 6 cases-anesthesia-analgesia.org 127 Copyright © 2017 International Anesthesia Research Society DOI: 10.1213/XAA.0000000000000448 The use of a cuffed endotracheal tube (ETT) has become standard of care in pediatric anesthesia. This applies even to neonates and infants and increasingly to pediatric intensive care medicine.1 The main advantage of using cuffed ETTs in children is the markedly reduced tube exchange rate to find an appropriately sized ETT with a smooth fit and a good seal of the pediatric airway when compared with uncuffed ETTs.2 Fundamental advances in the understanding of the pediatric upper airway anatomy and the availability of newer cuffed pediatric ETTs have changed the old historical practice to seal the pediatric airway using an uncuffed ETT just fitting into and/or slightly deforming the elliptical shaped cricoid (cricoidal sealing).3,4 This is in contrast to the use of a slightly smaller-sized cuffed ETT with a thin high-volume low-pressure (HVLP) cuff that allows the smooth passage through the vulnerable larynx and to gently seal the pediatric airway within the less susceptible trachea (tracheal sealing). Sealing the pediatric airway by means of a cuff within the trachea allows the anesthesiologist to compensate for the problem of age-related and individual variations of subglottic size within a certain age group of children. Both can result in high ETT exchange rates, insufficient sealing of the airway, and pressure-related lesions within the larynx when using uncuffed ETTs.2–5 With the use of modern pediatric cuffed ETTs, exchange rates range from 0% to 2.1% with a median cuff inflation pressure of about 10 cm H2O. This sufficiently seals the trachea without increasing the incidence of postextubation stridor. Postextubation stridor as a scientifically valid outcome measure for assessing the pediatric airway injury after endotracheal intubation has been vehemently criticized.9 Endoscopic data in children aged from birth to 6 years, however, did not reveal increased airway injury in children after short-term endotracheal intubation with a cuffed ETT when compared with children without earlier airway instrumentation.10 Many of the airway alterations so far attributed to endotracheal intubation were found in children who had never undergone intubation before. Endoscopic results of prolonged endotracheal intubation with uncuffed and cuffed ETTs in pediatric intensive care patients are expected for 2017 (ClinicalTrials.gov NCT02350933). It must be emphasized that the above-mentioned benefits and safety of cuffed ETTs in children are only achieved if careful endotracheal intubation, confirmation of an air leak with the cuff not inflated, cuff pressure limitation to a maximum of 20 cm H2O, strictly evidence-based selection of ETT size, and the use of an ETT designed to fit the pediatric anatomy are guaranteed.11 The case report by Imai et al12 in this issue of A&A Case Reports documents the cons","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75595699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}