Assessment of early paediatric airway sequelae after using cuffed or uncuffed endotracheal tubes with ultrasound and flexible endoscopy

Abstract

ABSTRACT Background Cuffed tracheal tubes (CTT) emerge to prevent air leakage despite that most anaesthesiologists prefer the uncuffed tracheal tubes (UTT) in the paediatrics. Using recent tools for evaluation of endotracheal intubation sequelae may help to prevent airway injury and determine the appropriate type and size of endotracheal tube (ETT). Purpose The study aimed to detect the early airway changes after using CTT or UTT in paediatrics. Also, to find out the correlation between the endoscopic and ultrasonographic findings in detection of post intubation sequelae in paediatrics. Methods A prospective, randomized study was performed over 80 children aged from two to five years, scheduled for abdominal surgeries under the effect of general anaesthesia. Patients were assigned into two equal groups: Group C: CTT and Group U: UTT. Results There was less statistically significant ETT exchange in the group C (p = 0.020). No significant difference could be found as regard to the change in the subglottic diameter, the incidence of stridor, laryngospasm and croup, and the occurrence of airway injuries. There was a positive correlation between the change in the subglottic diameter and the prevalence of airway injuries (P = 0.014). The duration of the endotracheal intubation could not influence the incidence of neither the stridor nor the airway injuries in both groups. Conclusion There were no difference between the use of CTT or UTT in the paediatrics in terms of early airway changes. However, the rate of tube exchange is significantly lower when using CTT. A positive correlation is found between the endoscopic and ultrasound findings in the detection of post intubation sequelae in paediatrics. Short-term endotracheal intubation neither affects the incidence nor the severity of airway injuries. Using the external diameter of the endotracheal tube instead of the inner diameter is crucial for proper sizing in paediatrics.