Advantages (with some body of evidence): | Potential disadvantages (with no evidence): |
Decreased reintubation rate to find correct sized ETT8 14 16 37 38 | Increased airway damage if the cuffed ETTs are not used correctly |
Decreased clinically significant ETT leak14 | |
Decreased aspiration18 39 and ventilator-associated pneumonia20 | Smaller 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.