Respiratory Complications Between Cuffed and Uncuffed Endotracheal Tubes in Pediatric Respiratory Management After Palatoplasty: Single-Center Retrospective Cohort Study

Abstract

OBJECTIVES: We aimed to examine the associations between use of cuffed or uncuffed endotracheal tubes (ETTs) and complications during and after short-term intubation of post-palatoplasty patients without intrinsic lung disease. DESIGN: Retrospective cohort study. SETTING: Operating room and PICU. PATIENTS: Children without intrinsic lung disease who had undergone palatoplasty at a single institution. Inclusion criteria: intubation using ETTs with an internal diameter of 3.5 mm and postoperative management in the PICU. Exclusion criteria: 1) patients for whom ETTs with internal diameters other than 3.5 mm were used, 2) patients who had already been extubated in the operating room, and 3) patients who had a tracheostomy. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Eighty-seven patients were screened for eligibility; 71 met the inclusion criteria. Of the 71 patients, 41 (58%) with polyurethane-cuffed ETTs (PUC-ETTs) and 30 (42%) with uncuffed ETTs were enrolled. We failed to identify an association between type of PUC-ETT and the development of atelectasis (odds ratio [OR], 1.06; 95% CI, 0.35-3.20; p = 1.00). Similarly, we failed to identify an association between type of PUC-ETT and development of stridor (OR, 1.58; 95% CI, 0.43-5.81; p = 0.715) or hoarseness after extubation (OR, 7.03; 95% CI, 0.83-59.6; p = 0.10). At extubation, air leak pressure was higher in the PUC-ETT group than in the uncuffed ETT group (p < 0.001), a finding which was not evident at intubation. The number of patients who received IV dexamethasone and the cases of inhaled racemic epinephrine were not statistically significant. CONCLUSIONS: In this select population of post-palatoplasty infants without intrinsic lung disease, we failed to identify any association between type of ETT (cuffed or uncuffed) and greater odds of developing respiratory complications. Taken together with the 95% CI of the effect size, our data indicate continued uncertainty about type of ETT that should be used for short-term intubation.