BJA Advance Access originally published online on November 3, 2009
British Journal of Anaesthesia 2009 103(6):867-873; doi:10.1093/bja/aep290
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Prospective randomized controlled multi-centre trial of cuffed or uncuffed endotracheal tubes in small children#
1 Department of Anaesthesia, University Children's Hospital Zurich, Steinwiessstrasse 75, CH 8032 Zurich, Switzerland
2 Mannheim Institute of Public Health, University of Heidelberg, Germany
3 Department of Anaesthesia, Schulthess Clinic, Zurich, Switzerland
* Corresponding author. E-mail: markus.weiss{at}kispi.uzh.ch
Background: The use of cuffed tracheal tubes (TTs) in small children is still controversial. The aim of this study was to compare post-extubation morbidity and TT exchange rates when using cuffed vs uncuffed tubes in small children.
Methods: Patients aged from birth to 5 yr requiring general anaesthesia with TT intubation were included in 24 European paediatric anaesthesia centres. Patients were prospectively randomized into a cuffed TT group (Microcuff® PET) and an uncuffed TT group (Mallinckrodt®, Portex®, Rüsch®, Sheridan®). Endpoints were incidence of post-extubation stridor and the number of TT exchanges to find an appropriate-sized tube. For cuffed TTs, minimal cuff pressure required to seal the airway was noted; maximal cuff pressure was limited at 20 cm H2O with a pressure release valve. Data are mean (SD).
Results: A total of 2246 children were studied (1119/1127 cuffed/uncuffed). The age was 1.93 (1.48) yr in the cuffed and 1.87 (1.45) yr in the uncuffed groups. Post-extubation stridor was noted in 4.4% of patients with cuffed and in 4.7% with uncuffed TTs (P=0.543). TT exchange rate was 2.1% in the cuffed and 30.8% in the uncuffed groups (P<0.0001). Minimal cuff pressure required to seal the trachea was 10.6 (4.3) cm H2O.
Conclusions: The use of cuffed TTs in small children provides a reliably sealed airway at cuff pressures of 
20 cm H2O, reduces the need for TT exchanges, and does not increase the risk for post-extubation stridor compared with uncuffed TTs.
Keywords: anaesthesia, paediatric; complications, stridor; equipment, cuffs tracheal; equipment, tubes tracheal
Declaration of interest. M.W. and A.G. are involved in the development and evaluation of new cuffed paediatric tracheal tubes in co-operation with Microcuff GmbH, Weinheim, Germany, Covidien, Athlone, Ireland, and Kimberly Clark, Health Care, Atlanta, GA, USA.
Members of the European Paediatric Endotracheal Intubation Study Group are listed in the Appendix.
# This article is accompanied by Editorial I.
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  P. A. Lonnqvist Cuffed or uncuffed tracheal tubes during anaesthesia in infants and small children: time to put the eternal discussion to rest? Br. J. Anaesth., December 1, 2009; 103(6): 783 - 785. [Full Text] [PDF]
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