Thomas Rebecca E, Rao Shripada C, Minutillo Corrado, Hullett Bruce, Bulsara Max K
Neonatal Clinical Care Unit, Princess Margaret Hospital for Children and King Edward Memorial Hospital for Women, Perth, WA, Australia.
Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia.
Paediatr Anaesth. 2018 Mar;28(3):204-209. doi: 10.1111/pan.13311. Epub 2018 Jan 9.
Cuffed endotracheal tubes are being increasingly used in infants; however, current evidence in the literature mostly includes infants ≥ 3-kg weight.
The aim of this observational study was to compare the short-term outcomes with the use of Microcuff cuffed vs uncuffed endotracheal tubes in neonates < 3 kg.
We performed a retrospective cohort study in a single-centre, tertiary children's hospital neonatal intensive care unit. The study included all infants < 3 kg receiving Microcuff cuffed endotracheal tubes over the period January 2015 to January 2016. Controls were all infants 2000-2999 g receiving an uncuffed endotracheal tube over the period September 2015 to January 2016.
Twenty-three patients < 3 kg were intubated with cuffed endotracheal tubes. All were inserted in the operating room. Of 23 patients, 14 (60.9%) patients had the cuff inflated in the operating room and none subsequently in the neonatal intensive care unit. The group receiving cuffed endotracheal tubes was compared with 23 patients with uncuffed endotracheal tubes. There was no difference in weight (median 2620 g vs 2590 g, diff in median = 10, 95% CI -120, 130) or duration of intubation (median 27 vs 44 hours, diff in median = 17, 95% CI -5, 46). However, there was a significant difference in gestational age (median 37 vs 35 weeks, diff in median = -1, 95% CI -2, 0) and age at intubation (median 6 vs 0 days, diff in median = -4, 95% CI -10, -1). There were no significant differences in the rates of: change of endotracheal tube to find correct size (0/23 vs 4/23, P = .109, OR = 0.13, 95% CI 0.01, 1.41); median ventilator leak reading (0% [IQR 0%-12%] vs 0% [IQR 0%-5.5%], P = .201, diff in median = 0, 95% CI -5.5, 0); unplanned extubations (0/23 vs 2/23; atelectasis (4/23 vs 0/23; endotracheal tube blockage (0/23 vs 0/23; pneumonia (0/23 vs 0/23; or postextubation stridor (1/23 vs 2/23).
This retrospective study with a small sample size found that Microcuff cuffed endotracheal tubes may be safe in neonates < 3 kg. Well-designed randomized controlled trials are needed to address this issue definitively.
带套囊气管内导管在婴儿中的使用越来越普遍；然而，目前文献中的证据大多来自体重≥3千克的婴儿。
本观察性研究旨在比较在体重<3千克的新生儿中使用带微型套囊的带套囊气管内导管与不带套囊气管内导管的短期结局。
我们在一家单中心三级儿童医院的新生儿重症监护病房进行了一项回顾性队列研究。该研究纳入了2015年1月至2016年1月期间所有体重<3千克且接受带微型套囊气管内导管的婴儿。对照组为2015年9月至2016年1月期间所有体重2000 - 2999克且接受不带套囊气管内导管的婴儿。
23例体重<3千克的患者接受了带套囊气管内导管插管。所有导管均在手术室插入。23例患者中，14例（60.9%）在手术室给套囊充气，之后在新生儿重症监护病房均未再充气。将接受带套囊气管内导管的组与23例接受不带套囊气管内导管的患者进行比较。体重（中位数2620克对2590克，中位数差值 = 10，95%置信区间 -120，130）或插管持续时间（中位数27小时对44小时，中位数差值 = 17，95%置信区间 -5，46）无差异。然而，胎龄（中位数37周对35周，中位数差值 = -1，95%置信区间 -2，0）和插管时年龄（中位数6天对0天，中位数差值 = -4，95%置信区间 -10，-1）存在显著差异。在以下方面的发生率无显著差异：更换气管内导管以找到合适尺寸（0/23对4/23，P = 0.109，比值比 = 0.13，95%置信区间0.01，1.41）；中位呼吸机漏气读数（0%[四分位间距0% - 12%]对0%[四分位间距0% - 5.5%]，P = 0.201，中位数差值 = 0，95%置信区间 -5.5，0）；非计划拔管（0/23对2/23）；肺不张（4/23对0/23）；气管内导管堵塞（0/23对0/23）；肺炎（0/23对0/23）；或拔管后喘鸣（1/23对2/23）。
这项小样本回顾性研究发现，带微型套囊的带套囊气管内导管在体重<3千克的新生儿中可能是安全的。需要设计良好的随机对照试验来明确解决这一问题。
