Table 2

Studies comparing cuffed ETTs versus uncuffed ETTs for short-term use in anaesthesia

AuthorType of studyParticipantsOutcomesMain resultsComments
Khine et al8RCT488 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 al16Multicentre 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 al17RCT70 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 al14Retrospective cohort study327 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.