Evolution of the concepts of pediatric airway and endotracheal intubation

The tenets of airway anatomy and management continue to be reevaluated and challenged as our knowledge increases. This has led to a better understanding of the pediatric airway and its critical differences from adults. This evolving understanding of the pediatric airway size and shape has significant clinical implications to airway management in the operating room, emergency department, and the intensive care unit. The first significant change in clinical practice was the transition to the routine use of cuffed endotracheal tubes (ETTs). This was facilitated by the availability of the Microcuff® with a polyurethane cuff and a redesigned position of the cuff on the shaft of the ETT without the Murphy's eye. Additional attention to the design and the location of the cuff on the ETT may be necessary as well as to markings for depth of intubation on the shaft of the ETT to ensure that the cuff is placed fully below the cricoid ring following endotracheal intubation. Inflation of the cuff with high intracuff pressures within the cricoid ring may compromise perfusion of the tracheal mucosa and result in airway injury.