Studies comparing cuffed ETTs versus uncuffed ETTs for short-term use in anaesthesia
| Author | Type of study | Participants | Outcomes | Main results | Comments |
|---|---|---|---|---|---|
| Khine et al8 | RCT | 488 children from birth to 8 years of age (251 cuffed: 237 uncuffed) requiring anaesthesia for surgery. | (A) Number of intubations required to achieve appropriately sized ETT, (B) the need to use >2 L/min fresh gas flow, (C) concentration of nitrous oxide (N2O) in the operating room, and (D) incidence of croup were compared. | (1) In patients <2 years age, the ETT exchange rate was 0% cuffed ETT: 30% uncuffed ETT. (2) Requirement for >2 L/min fresh gas flow was significantly less with cuffed ETTs (1.2%) vs those with uncuffed ETTs (11%) (p<0.001). (3) Ambient N2O concentration exceeded 25 ppm in 0% cuffed ETT: 37% uncuffed ETT (p<0.001). (4) No difference in treatment for stridor between 2 groups (1.2% cuffed: 1.3% uncuffed). | Mallinckrodt lo-pro or Sheridan low-pressure cuffed ETTs were used. |
| Weiss et al16 | Multicentre RCT (24 centres across Europe) | 2246 children birth–5 years of age requiring anaesthesia for surgery (1119 cuffed: 1127 uncuffed). 624 patients aged 0–8 months (28% of the patient sample). | (A) Incidence of postextubation stridor and (B) ETT exchange rates. | (1) No difference in postextubation stridor was noted (4.4% cuffed: 4.7% uncuffed (p=0.543). (2) ETT exchange rate 2.1% cuffed: 30.8% uncuffed groups (p<0.001). (3) Minimal cuff pressure required to seal the trachea was 10.6 (4.3) cm H2O with the cuffed ETTs. | Standardised Microcuff cuffed ETT vs non-standardised uncuffed ETT. |
| Eschertzhuber et al17 | RCT | 70 children aged 0–5 years (35 cuffed: 35 uncuffed) undergoing surgery. | Anaesthetic gas consumption using cuffed vs uncuffed ETTs. | With use of cuffed ETTs there was significantly less: (1) Fresh gas flow requirement (cuffed 1.0 (0.5–1.0) L/min: uncuffed 2.0 (0.5–4.3) L/min, p<0.001), (2) sevoflurane use (cuffed 6.2 (1.1–14.9) mL: uncuffed16.1 (6.4–82.8) mL, p=0.003), and (3) medical gas use (cuffed 46 (9/149) L: uncuffed 129 (53–552), p<0.001). (4) Total costs for sevoflurane and medical gases significantly less in the cuffed ETT group (cuffed €5.2 (1.0–12.5): uncuffed €13.4 (6.0–67.3), p<0.001). (5) Concluded that increased cost of cuffed ETTs is compensated by reduction in gas consumption. | |
| Dorsey et al14 | Retrospective cohort study | 327 burns patient aged 0–10 years undergoing anaesthetic (228 intubation events where the type of ETT used was clear, 111 cuffed: 117 uncuffed), over 10 year period 1998–2007. | Review of adverse events. | (1) They showed clinically significant loss of tidal volume with uncuffed ETTs (OR 10.62, 95% CI 2.2 to 50.5, p=0.003) and (2) clinically significant higher requirement for immediate reintubation to change ETT size/type with uncuffed ETTs (cuffed 7.2%: uncuffed 37.6%, OR 5.54, 95% CI 1.1 to 13.6). (3) No significant differences in rates of postextubation stridor (7.2% cuffed: 4.3% uncuffed), self-extubation (0.9% both groups), aspiration (0 patients, both groups) and failed extubation (1.8% cuffed: 3.4% uncuffed). (4) When the sample was restricted to age 0–2 years, (A) reintubations were significantly higher in the uncuffed group (OR 10.0, 95% CI 2.1 to 48.5, p=0.004). (B) There were no clinically significant air leaks in the cuffed ETT group, whereas there were significant air leaks in 19.4% of the uncuffed ETT group. | Not randomised. Rate of cuffed ETT use increased over the studied years. |
ETT, endotracheal tube; RCT, randomised controlled trial.