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The Microcuff^TM tube allows a longer time interval until unsafe cuff pressures are reached in children

[Le tube Microcuff^TM, utilisé chez les enfants, prolonge l’intervalle précédant l’atteinte de pressions dangereuses du ballonnet]

From the Department of Anesthesia, University Children’s Hospital, Zurich, Switzerland.

Address correspondence to: Dr. Alexander Dullenkopf, Department of Anesthesia, University Children’s Hospital, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland. Phone: +41 1 266 77 29; Fax: +41 1 266 79 94; E-mail: alex.dullenkopf{at}kispi.unizh.ch

Purpose: To compare cuff pressures during nitrous oxide exposure in the new Microcuff pediatric tracheal tube (MPT) with ultrathin high volume - low pressure polyurethane cuff to a tube with a standard polyvinyl chloride (PVC) cuff.

Methods: With approval of the local Ethics Committee, 30 pediatric patients requiring tracheal intubation [tube size internal diameter (ID) 4.0 mm, or ID 7.0 mm) were included. Patients were randomly divided in three groups: A) MPT, baseline cuff pressure 20 cm H₂O; B) PVC, baseline cuff pressure 20 cm H₂O; and C) MPT, baseline cuff pressure set to sealing pressure. Anesthesia technique and ventilator settings were standardized. The time required for cuff pressure to increase to 25 cm H₂O was recorded and pressure reduced to baseline. The number of gas removals required during the first hour was noted. Data are median (range). Groups were compared by the Kruskal-Wallis test (P < 0.05).

Results: There were no differences between groups in patient characteristics. PVC and MPT cuffs inflated to a baseline pressure of 20 cm H₂O were similar regarding the time to first removal of gas [A: nine minutes (4–24), B: eight minutes (4–46)], and number of removals required [A: four (2–6), B: three (1–5)]. In MPT with baseline pressure set to sealing pressure [10 cm H₂O (8–14)] time to first gas removal and number of removals were significantly less (P < 0.05).

Conclusion: When baseline inflation pressure was set at 20 cm H₂O, cuff pressure increased similarly in MPT and PVC tubes. When inflated just to sealing pressure, the MPT allowed a longer time interval until the upper limit of 25 cm H₂O was reached.