Skip to main content
SpringerLink
Log in

Cuffed versus uncuffed endotracheal tubes in children: a meta-analysis

  • Original Article
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

Purpose

Cuffed endotracheal tubes (ETTs) have increasingly been used in small children. However, the use of cuffed ETTs in small children is still controversial. The goal of this meta-analysis is to assess the current evidence regarding the postextubation morbidity and tracheal tube (TT) exchange rate of cuffed ETTs compared to uncuffed ETTs in children.

Methods

A systematic literature search in PubMed, Web of Science, Embase, and Cochrane Central Register of Controlled Trials up to November 2014 was conducted to identify randomized controlled trials (RCTs) and prospective cohort studies that compared the use of cuffed and uncuffed ETTs in children. The primary outcome was the incidence of postextubation stridor and the second outcomes were the TT exchange rate, need for re-intubation, and duration of tracheal intubation. All pooled data were estimated using random effects meta-analysis.

Results

Two RCTs and two prospective cohort studies including 3782 patients, in which 1979 patients for cuffed tubes and 1803 patients for uncuffed tubes, were included in our analysis. We found that the use of cuffed ETTs did not significantly increase the incidence of postextubation stridor (RR = 0.88; 95 % CI 0.67–1.16, p = 0.36), and the TT exchange rate was lower in patients receiving cuffed tubes intubation (RR, 0.07; 95 % CI 0.05–0.10, p < 0.00001). The need for re-intubation following planned extubations and duration of tracheal intubation did not differ significantly between the cuffed tube group and the uncuffed tube group.

Conclusions

Our study demonstrates that cuffed ETTs reduce the need for TT exchanges and do not increase the risk for postextubation stridor compared with uncuffed ETTs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Veyckemans F. New developments in the management of the paediatric airway: cuffed or uncuffed tracheal tubes, laryngeal mask airway, cuffed oropharyngeal airway, tracheostomy and one-lung ventilation devices. Curr Opin Anaesthesiol. 1999;12:315–20.

    Article  CAS  PubMed  Google Scholar 

  2. Flynn PE, Black AE, Mitchell V. The use of cuffed tracheal tubes for paediatric tracheal intubation, a survey of specialist practice in the United Kingdom. Eur J Anaesthesiol. 2008;25:685–8. doi:10.1017/S0265021508003839.

    Article  CAS  PubMed  Google Scholar 

  3. Weiss M, Dullenkopf A, Gysin C, Dillier CM, Gerber AC. Shortcomings of cuffed paediatric tracheal tubes. Br J Anaesth. 2004;92:78–88.

    Article  CAS  PubMed  Google Scholar 

  4. Eschertzhuber S, Salgo B, Schmitz A, Roth W, Frotzler A, Keller CH, Gerber AC, Weiss M. Cuffed endotracheal tubes in children reduce sevoflurane and medical gas consumption and related costs. Acta Anaesthesiol Scand. 2010;54:855–8. doi:10.1111/j.1399-6576.2010.02261.x.

    Article  CAS  PubMed  Google Scholar 

  5. Gopalareddy V, He Z, Soundar S, Bolling L, Shah M, Penfil S, McCloskey JJ, Mehta DI. Assessment of the prevalence of microaspiration by gastric pepsin in the airway of ventilated children. Acta Paediatr. 2008;97:55–60. doi:10.1111/j.1651-2227.2007.00578.x.

    Article  CAS  PubMed  Google Scholar 

  6. Bhardwaj N. Pediatric cuffed endotracheal tubes. J Anaesthesiol Clin Pharmacol. 2013;29:13–8. doi:10.4103/0970-9185.105786.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Weiss M, Gerber AC. Safe use of cuffed tracheal tubes in children. Anasthesiol Intensivmed Notfallmed Schmerzther. 2012;47:232–7. doi:10.1055/s-0032-1310411.

    Article  PubMed  Google Scholar 

  8. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6:e1000100. doi:10.1371/journal.pmed.1000100.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(264–269):W64.

    Google Scholar 

  10. Phillips B BCSD (2009) Levels of evidence and grades of recommendation. Oxford Centre for Evidence-based Medicine Web site. http://www.cebm.net/index.aspx?o=1025.

  11. Higgins JGS. Cochrane handbook for systematic reviews of interventions. New York: Wiley; 2008.

    Book  Google Scholar 

  12. Wells G SBOC (2014) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Hospital Research Institute Web site. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed Aug 6 2014.

  13. Fan X, Lin T, Xu K, Yin Z, Huang H, Dong W, Huang J. Laparoendoscopic single-site nephrectomy compared with conventional laparoscopic nephrectomy: a systematic review and meta-analysis of comparative studies. Eur Urol. 2012;62:601–12. doi:10.1016/j.eururo.2012.05.055.

    Article  PubMed  Google Scholar 

  14. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5:13. doi:10.1186/1471-2288-5-13.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Hedges LV, Pigott TD. The power of statistical tests in meta-analysis. Psychol Methods. 2001;6:203–17.

    Article  CAS  PubMed  Google Scholar 

  16. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58. doi:10.1002/sim.1186.

    Article  PubMed  Google Scholar 

  17. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88.

    Article  CAS  PubMed  Google Scholar 

  18. Khine HH, Corddry DH, Kettrick RG, Martin TM, McCloskey JJ, Rose JB, Theroux MC, Zagnoev M. Comparison of cuffed and uncuffed endotracheal tubes in young children during general anesthesia. Anesthesiology. 1997;86(627–631):27A.

    Google Scholar 

  19. Weiss M, Dullenkopf A, Fischer JE, Keller C, Gerber AC. Prospective randomized controlled multi-centre trial of cuffed or uncuffed endotracheal tubes in small children. Br J Anaesth. 2009;103:867–73. doi:10.1093/bja/aep290.

    Article  CAS  PubMed  Google Scholar 

  20. Deakers TW, Reynolds G, Stretton M, Newth CJ. Cuffed endotracheal tubes in pediatric intensive care. J Pediatr. 1994;125:57–62.

    Article  CAS  PubMed  Google Scholar 

  21. Newth CJ, Rachman B, Patel N, Hammer J. The use of cuffed versus uncuffed endotracheal tubes in pediatric intensive care. J Pediatr. 2004;144:333–7. doi:10.1016/j.jpeds.2003.12.018.

    Article  PubMed  Google Scholar 

  22. Ashtekar CS, Wardhaugh A. Do cuffed endotracheal tubes increase the risk of airway mucosal injury and post-extubation stridor in children? Arch Dis Child. 2005;90:1198–9. doi:10.1136/adc.2005.077651.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Orliaguet GA, Renaud E, Lejay M, Meyer PG, Schmautz E, Telion C, Carli PA. Postal survey of cuffed or uncuffed tracheal tubes used for paediatric tracheal intubation. Paediatr Anaesth. 2001;11:277–81.

    Article  CAS  PubMed  Google Scholar 

  24. Litman RS, Maxwell LG. Cuffed versus uncuffed endotracheal tubes in pediatric anesthesia: the debate should finally end. Anesthesiology. 2013;118:500–1. doi:10.1097/ALN.0b013e318282cc8f.

    Article  PubMed  Google Scholar 

  25. Silva MJ, Aparicio J, Mota T, Spratley J, Ribeiro A. Ischemic subglottic damage following a short-time intubation. Eur J Emerg Med. 2008;15:351–3. doi:10.1097/MEJ.0b013e3282fc9c5d.

    Article  PubMed  Google Scholar 

  26. Schramm C, Knop J, Jensen K, Plaschke K. Role of ultrasound compared to age-related formulas for uncuffed endotracheal intubation in a pediatric population. Paediatr Anaesth. 2012;22:781–6. doi:10.1111/j.1460-9592.2012.03889.x.

    Article  PubMed  Google Scholar 

  27. von Rettberg M, Thil E, Genzwurker H, Gernoth C, Hinkelbein J. Endotracheal tubes in pediatric patients. Published formulas to estimate the optimal size. Anaesthesist. 2011;60:334–42. doi:10.1007/s00101-010-1756-0.

    Article  Google Scholar 

  28. Lonnqvist PA. Cuffed or uncuffed tracheal tubes during anaesthesia in infants and small children: time to put the eternal discussion to rest? Br J Anaesth. 2009;103:783–5. doi:10.1093/bja/aep330.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This research work was carried out without funding.

Author information

Authors and Affiliations

  1. Department of Anaesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China

    Fenmei Shi

  2. Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China

    Ying Xiao, Wei Xiong, Qin Zhou & Xiongqing Huang

Authors
  1. Fenmei Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ying Xiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wei Xiong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Qin Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiongqing Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xiongqing Huang.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shi, F., Xiao, Y., Xiong, W. et al. Cuffed versus uncuffed endotracheal tubes in children: a meta-analysis. J Anesth 30, 3–11 (2016). https://doi.org/10.1007/s00540-015-2062-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-015-2062-4

Keywords

Search

Navigation