RT Journal Article
SR Electronic
T1 Comparison of the efficacy and safety of cuffed versus uncuffed endotracheal tubes for infants in the intensive care setting: a pilot, unblinded RCT
JF Archives of Disease in Childhood - Fetal and Neonatal Edition
JO Arch Dis Child Fetal Neonatal Ed
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP fetalneonatal-2020-320764
DO 10.1136/archdischild-2020-320764
A1 Rebecca E Thomas
A1 Simon Erickson
A1 Bruce Hullett
A1 Corrado Minutillo
A1 Martyn Lethbridge
A1 Shyan Vijayasekaran
A1 Sachin Agrawal
A1 Max K Bulsara
A1 Shripada C Rao
YR 2021
UL http://fn.bmj.com/content/early/2021/04/19/archdischild-2020-320764.abstract
AB Objective To study effectiveness and safety of cuffed versus uncuffed endotracheal tubes (ETTs) in small infants in the intensive care unit (ICU).Design Pilot RCT.Setting Neonatal and paediatric ICUs of children’s hospital in Western Australia.Participants Seventy-six infants ≥35 weeks gestation and infants <3 months of age, ≥3 kg.Interventions Patients randomly assigned to Microcuff cuffed or Portex uncuffed ETT.Main outcomes measures Primary outcome was achievement of optimal ETT leak in target range (10%–20%). Secondary outcomes included: reintubations, ventilatory parameters, ventilatory complications, postextubation complications and long-term follow-up.Results Success rate (achievement of mean leak in the range 10%–20%) was 13/42 (30.9%) in the cuffed ETT group and 6/34 (17.6%) in uncuffed ETT group (OR=2.09; 95% CI (0.71 to 6.08); p=0.28). Mean percentage time within target leak range in cuffed ETT group 28% (IQR: 9–42) versus 15% (IQR: 0–28) in uncuffed ETT group (p=0.01). There were less reintubations to optimise size in cuffed ETT group 0/40 versus 10/36 (p<0.001). No differences were found in gaseous exchange, ventilator parameters or postextubation complications. There were fewer episodes of atelectasis in cuffed ETT group 0/42 versus 4/34 (p=0.03). No patient had been diagnosed with subglottic stenosis at long-term follow-up.Conclusions There was no difference in the primary outcome, though percentage time spent in optimal leak range was significantly higher in cuffed ETT group. Cuffed ETTs reduced reintubations to optimise ETT size and episodes of atelectasis. Cuffed ETTs may be a feasible alternative to uncuffed ETTs in this group of patients.Trial registration number ACTRN12615000081516.The data that support the findings of this study are available from the corresponding author upon reasonable request.