Uncuffed endotracheal tubes should not be used in seriously burned children

Abstract

Objective: To document a complication associated with placement of uncuffed endotracheal tubes in seriously burned children. Design: Retrospective review. Setting: Verified pediatric burn center. Patients/Subjects: Acutely burned children requiring urgent replacement of uncuffed endotracheal tubes with cuffed endotracheal tubes over a 5-yr period. Interventions: In all children, the reason behind the need for urgent tube change was uncontrollable air leak, despite properly sized uncuffed endotracheal tubes, as respiratory failure progressed and compliance worsened. Results: These two girls and three boys had an average age of 2.2 ± 1.0 yrs, burn size of 41% ± 6.1% of the body surface, and subsequently required mechanical ventilation for an average of 23.6 ± 6.3 days. Urgent tube change was required an average of 64.2 ± 43.8 hrs after arrival in the burn unit (87.6 ± 49.4 hrs after injury). Although successful in all children, massive facial edema rendered tube change potentially dangerous. The intervention would not have been necessary if cuffed endotracheal tubes had been placed initially. All children went on to survive their injury, without further tube change or tracheostomy. Conclusion: If children are critically burned and expected to require more than transient mechanical ventilatory support, low-pressure cuffed endotracheal tubes should be placed, regardless of the child’s age.