Endotracheal Tubes in Paediatric Anaesthesia: The Cuffed Versus Uncuffed Debate

Abstract

The paediatric airway demands respect, and appropriate and safe management of this delicate structure is of utmost importance.

With development of polyvinyl chloride (PVC) in the 1960s, uncuffed endotracheal tubes (ETTs) replaced tracheostomies for long-term intubation and ventilation in the intensive care unit (ICU). Since then, uncuffed ETTs have traditionally been used in infants and children under the age of eight (or even ten) years for both short- and long-term intubation in theatre and ICU. Cuffed ETTs were not considered appropriate in this age group, and until fairly recently many manufacturers of ETTs did not produce cuffed sizes smaller than a 5 mm internal diameter (ID). However, debate in the literature over the last decade questions this teaching, some saying that the routine use of uncuffed ETTs in infants and children is not based on scientific evidence. It is clear that the strongly emerging role of cuffed ETTs in the paediatric population has come to the fore.