Table 1

Summary of the advantages and disadvantages of cuffed ETTs in the NICU/PICU setting

Advantages (with some body of evidence):Potential disadvantages (with no evidence):
Decreased reintubation rate to find correct sized ETT8 14 16 37 38Increased airway damage if the cuffed ETTs are not used correctly
Decreased clinically significant ETT leak14
Decreased aspiration18 39 and ventilator-associated pneumonia20Smaller diameter ETT:
Decreased fresh and volatile gas use and less air pollution8 9 17 Increased ETT blockage/decreased successful suctioning of secretions
 Increased ventilator/pressure requirements (due to increased ETT resistance)
Potential advantages (with no evidence): Increased work of breathing on being weaned from ventilator
Due to decreased ETT leak:
 Improved ventilation
 Maintenance of PEEP
 Less incidence ventilator associated atelectasis
 More likely to be able to successfully use set volume guarantee/control ventilation
 More likely to successfully record capnography trace
Cause less airway damage due to:
 Smaller ETT sitting through cricoid
 Less traumatic intubation as ETT smaller
 Inflated cuff lifting ETT tip of anterior wall trachea
 Fewer total intubations
 Less accidental extubations
  • ETT, endotracheal tube; PEEP, peak end-expiratory pressure; PICUs, paediatric intensive care units; NICU, neonatal intensive care unit.