Chen Liang, Zhang Jun, Pan Guoshi, Li Xia, Shi Tianwu, He Wensheng
Department of Anesthesiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Medical University of Anhui, No. 246 Heping Road, Hefei, 230011, Anhui Province, China.
Open Med (Wars). 2018 Sep 8;13:366-373. doi: 10.1515/med-2018-0055. eCollection 2018.
Cuffed and uncuffed endotracheal tubes are commonly used for pediatric patients in surgery and emergency situations. It is still controversial which approach should be adopted. The purpose of the study was to compare the application of cuffed and uncuffed endotracheal tubes in pediatric patients.
We searched PubMed, Web of Science and Cochrane Library for clinical trials, which compared the two applications in children. The study characteristics and clinical data were summarized by two independent reviewers. Meta-analysis of the data was done using Revman 5.3 software.
6 studies with 4141 cases were included in this meta-analysis. The pooling analysis showed that more patients need tube changes in uncuffed than cuffed tubes (OR: 0.07, 95% CI: 0.05-0.10, P < 0.00001). However, there were no differences on intubation duration, reintubation occurrence, accidental extubation rate, croup occurrence and racemic epinephrine use during the intubation process. Also we didn't find any differences on laryngospasm and stridor occurrence after extubation.
Our study demonstrated that uncuffed endotracheal tubes increased the need for tube changes. Other incidences or complications between the two groups had no differences. Cuffed tubes may be an optimal option for pediatric patients. But more trials are needed in the future.
带套囊和不带套囊的气管内导管常用于小儿外科手术和紧急情况。应采用哪种方法仍存在争议。本研究的目的是比较带套囊和不带套囊气管内导管在小儿患者中的应用情况。
我们检索了PubMed、科学网和考克兰图书馆，查找比较这两种导管在儿童中应用情况的临床试验。由两名独立审阅者总结研究特征和临床数据。使用Revman 5.3软件对数据进行荟萃分析。
本荟萃分析纳入了6项研究，共4141例病例。汇总分析显示，与带套囊导管相比，不带套囊导管需要更换导管的患者更多（比值比：0.07，95%置信区间：0.05 - 0.10，P < 0.00001）。然而，在插管持续时间、再次插管发生率、意外拔管率、喉炎发生率以及插管过程中使用消旋肾上腺素方面，两组并无差异。在拔管后喉痉挛和喘鸣的发生率方面，我们也未发现差异。
我们的研究表明，不带套囊的气管内导管增加了更换导管的需求。两组之间的其他发生率或并发症并无差异。带套囊导管可能是小儿患者的最佳选择。但未来还需要更多试验。
