Cuffed endotracheal tubes in children reduce sevoflurane and medical gas consumption and related costs: Cost effectiveness of cuffed paediatric tubes

Department of Anaesthesia and Intensive Care, Innsbruck Medical University, Innsbruck, Austria.
Acta Anaesthesiologica Scandinavica (Impact Factor: 2.32). 08/2010; 54(7):855-858. DOI: 10.1111/j.1399-6576.2010.02261.x


This study aims to evaluate sevoflurane and anaesthetic gas consumption using uncuffed vs. cuffed endotracheal tubes (ETT) in paediatric surgical patients.
Uncuffed or cuffed ETT were used in paediatric patients (newborn to 5 years) undergoing elective surgery in a randomized order. Duration of assessment, lowest possible fresh gas flow (minimal allowed FGF: 0.5 l/min) and sevoflurane concentrations used were recorded. Consumption and costs for sevoflurane and medical gases were calculated.
Seventy children (35 uncuffed ETT/35 cuffed ETT), aged 1.73 (0.01-4.80) years, were enrolled. No significant differences in patient characteristics, study period and sevoflurane concentrations used were found between the two groups. Lowest possible FGF was significantly lower in the cuffed ETT group [1.0 (0.5-1.0) l/min] than in the uncuffed ETT group [2.0 (0.5-4.3) l/min], P<0.001. Sevoflurane consumption per patient was 16.1 (6.4-82.8) ml in the uncuffed ETT group and 6.2 (1.1-14.9) ml in the cuffed ETT group, P=0.003. Medical gas consumption was 129 (53-552) l in the uncuffed ETT group vs. 46 (9-149) l in the cuffed ETT group, P<0.001. The total costs for sevoflurane and medical gases were 13.4 (6.0-67.3)euro/patient in the uncuffed ETT group and 5.2 (1.0-12.5)euro/patient in the cuffed ETT group, P<0.001.
The use of cuffed ETT in children significantly reduced the costs of sevoflurane and medical gas consumption during anaesthesia. Increased costs for cuffed compared with uncuffed ETT were completely compensated by a reduction in sevoflurane and medical gas consumption.

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    • "The need to use high fresh gas flows leads to atmospheric pollution by anesthetic gases increasing the health risk to operation theater personnel.[1718] The increased consumption of anesthetic gases also has economic implications.[19] The risk of aspiration, especially in children undergoing emergency abdominal surgeries, is also increased.[2021] "
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    ABSTRACT: Endotracheal intubation in children is usually performed utilizing uncuffed endotracheal tubes for conduct of anesthesia as well as for prolonged ventilation in critical care units. However, uncuffed tubes may require multiple changes to avoid excessive air leak, with subsequent environmental pollution making the technique uneconomical. In addition, monitoring of ventilatory parameters, exhaled volumes, and end-expiratory gases may be unreliable. All these problems can be avoided by use of cuffed endotracheal tubes. Besides, cuffed endotracheal tubes may be of advantage in special situations like laparoscopic surgery and in surgical conditions at risk of aspiration. Magnetic resonance imaging (MRI) scans in children have found the narrowest portion of larynx at rima glottides. Cuffed endotracheal tubes, therefore, will form a complete seal with low cuff pressure of <15 cm H2O without any increase in airway complications. Till recently, the use of cuffed endotracheal tubes was limited by variations in the tube design marketed by different manufacturers. The introduction of a new cuffed endotracheal tube in the market with improved tracheal sealing characteristics may encourage increased safe use of these tubes in clinical practice. A literature search using search words "cuffed endotracheal tube" and "children" from 1980 to January 2012 in PUBMED was conducted. Based on the search, the advantages and potential benefits of cuffed ETT are reviewed in this article.
    No preview · Article · Mar 2013 · Journal of Anaesthesiology Clinical Pharmacology
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    ABSTRACT: To examine the history of pediatric endotracheal intubation and the issues surrounding the change from uncuffed endotracheal tubes to cuffed endotracheal tubes, including pediatric airway anatomy, endotracheal tube design, complications, and safety concerns. Review of the literature. Although the use of cuffed endotracheal tubes in infants and children remains a topic of debate, the literature supports this change in practice. Meticulous attention must be given to intracuff pressure. Cuffed endotracheal tubes designed especially for the pediatric patient may increase the margin of safety.
    Preview · Article · Jan 2011 · Ochsner Journal
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    ABSTRACT: Over the past 5 years, there has been a change in the clinical practice of pediatric anesthesiology with a transition to the use of cuffed instead of uncuffed endotracheal tubes in infants and children. However, there are few studies evaluating the current practices of inflation of these cuffs and the intracuff pressures. There was no change dictated in clinical practice for these patients. During the first 30 min of the case, the pressure in the cuff was measured using a hand held manometer. Additional data collected included the patient's demographic data (age, weight, and gender), the size of the ETT, whether nitrous oxide was in use, whether the patient was breathing spontaneously or undergoing positive pressure ventilation, and the type of anesthesia provider (resident, fellow, CRNA or SRNA). The cohort for the study included 200 patients ranging in age from 1 month to 17 years and in weight from 3.5 to 99.1 kg. The average cuff pressure was 23 ± 22 cmH(2)O in the total cohort of 200 patients. The cuff pressure was ≥ 30 cmH(2)O in 47 of the 200 patients (23.5%). The average cuff pressure was significantly higher in patients who were 8 years of age or greater compared to younger patients. Additionally, there were significantly more patients with a cuff pressure ≥ 30 cmH(2)O in the ≥ 8 year old age group. Although no difference in the mean cuff pressure was noted when comparing staff anesthesia providers (pediatric anesthesiologist or CRNA) versus trainees (SRNA, anesthesiology resident, medical student or pediatric anesthesiology fellow), the incidence of significantly excessive cuff pressures (≥ 60 cmH(2)O) was higher in the trainee group versus the faculty group (12 of 99 versus 2 of 101, p<0.0001). Using current clinical practice to inflate the cuff, a significant percentage of pediatric patients have an intracuff pressure greater than the generally recommended upper limit of 30 cmH(2)O.
    No preview · Article · Jan 2012 · International journal of pediatric otorhinolaryngology
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