Cuffed endotracheal tubes in neonates and infants undergoing cardiac surgery are not associated with airway complications

• Published in: Journal of clinical anesthesia 2016-09, Vol.33, p.422-427
• Main Authors: DeMichele, Jennifer C., MD, Vajaria, Nikhil, MD, Wang, Hongyue, PhD, Sweeney, Dawn M., MD, Powers, Karen S., MD, Cholette, Jill M., MD
• Format: Article
• Language: English
• Subjects: Age; Airway management; Airway Management - adverse effects; Airway Management - methods; Airway Obstruction - etiology; Anesthesia & Perioperative Care; Cardiac Surgical Procedures - methods; Comorbidity; Congenital heart disease; Edema; Endotracheal intubation; Female; Heart surgery; Humans; Infant; Infant, Newborn; Intubation; Intubation, Intratracheal - adverse effects; Intubation, Intratracheal - instrumentation; Male; Newborn babies; Ostomy; Oxygen - blood; Pain Medicine; Pediatric anesthesia; Pediatrics; Postextubation stridor; Respiration, Artificial; Respiratory Sounds; Retrospective Studies; Thoracic surgery; Treatment Outcome; Ventilators
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2016.04.038

Abstract Study Objective To determine the incidence of postoperative airway complications in infants < 5 kg in weight undergoing cardiac surgery intubated with Microcuff (Kimberley-Clark, Roswell, GA) endotracheal tubes (ETTs). Design Retrospective review of infants weighing < 5.0 kg with congenital heart disease (CHD) presenting for cardiac surgery. Setting Single-center, tertiary pediatric cardiac critical care unit at a university hospital. Patients A total of 208 infants weighing < 5 kg underwent cardiac surgery for CHD from 2008 to 2013. Intervention Intubation with Microcuff (Kimberley-Clark) ETTs. Study Design Retrospective review of infants weighing < 5.0 kg with CHD presenting for cardiac surgery to a single-center tertiary care university hospital. Measurements: Perioperative data were collected. Primary outcome was development of tracheal stenosis and/or reintubation for stridor. Stridor was defined as mild (≤ 2 doses of racemic epinephrine), moderate (> 2 doses of racemic epinephrine), or severe (requiring reintubation). Secondary outcomes were variables possibly contributing to postextubation stridor. Infants with a tracheostomy, airway anomalies, and death prior to initial extubation were excluded. Logistic regression analysis was performed to evaluate the association between clinical risk factors and the incidence of postextubation stridor. Results A total of 208 infants weighing < 5 kg underwent cardiac surgery for CHD from 2008 to 2013; 12 subjects were excluded for death prior to initial extubation. No infant developed tracheal stenosis. The incidence of any stridor was 20.9% (95% confidence interval, 15.8%-27.1%) with severe stridor in 2 cases (1%). Age at surgery, weight, duration of intubation, dexamethasone use, and ETT size were not significantly associated with postextubation stridor. Presence of a comorbidity was significantly associated with stridor ( P = .01). Conclusions Microcuff ETTs in infants < 5.0 kg in weight undergoing cardiac surgery are associated with a low incidence of severe postextubation stridor. Because cuffed ETTs allow for improved control of ventilation/oxygenation and decreased risk of aspiration, they should be considered for use in this high-risk population. Larger studies are needed to confirm these results.