Is cuffed endotracheal intubation in neonates a safe practice?

Endotracheal intubation and ventilation for respiratory insufficiency is a common procedure in preterm and sick infants. Traditionally, uncuffed endotracheal tubes (ETTs) are used in neonatal units, however the use of cuffed ETTs is on the increase, despite the limited evidence. This literature study reviews the evidence available on the safety of cuffed versus uncuffed ETTs for respiratory support in neonates by examining the risk of post-extubation stridor and the need for re-intubation.

Femi Adeniyi
Neonatal Consultant
Neonatal Intensive Care Unit, East Lancashire Hospitals NHS Trust
femi.adeniyi@nhs.net

Kunle Oyedokun
Paediatric Consultant
Ormskirk Neonatal Unit, Mersey and West Lancashire Teaching Hospitals NHS Trust

Adeniyi F., Oyedokun K. Is cuffed endotracheal intubation in neonates a safe practice? Infant 2023; 19(4): 145-48.

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Keywords

endotracheal intubation; uncuffed endotracheal tube; cuffed endotracheal tube; re-intubation; stridor; neonatal airway; paediatric anaesthesiology

Key points

Unlike paediatric care, neonatal units commonly use traditional uncuffed ETTs rather than cuffed ETTs.
Cuffed ETTs may offer some benefits over uncuffed ETTs but are they safe for use in neonates?
This literature review provides information about the safe use of cuffed ETTs in neonates.
The available studies are limited but the critical appraisal demonstrates no difference in the risk of post-extubation stridor or re-intubation using cuffed versus uncuffed ETTs.

Also published in Infant:

VOLUME 8/ISSUE 6, NOVEMBER 2012

Should we be using high flow therapy on the neonatal unit?

High flow therapy (HFT) has become an increasingly popular alternative to continuous positive airway pressure (CPAP) within neonatal units. However, there is little uniformity in its usage reflecting the lack of evidence. This article summarises a review of the literature presenting the evidence for this therapy and data collected through a network survey and a tertiary neonatal unit audit.