Cuffed vs. Uncuffed Tracheal Tubes for Children: Time to Let Go of Old Dogma

Dogma suggests using uncuffed endotracheal tubes for children <8 years old. As the teaching goes, because the cricoid is the narrowest part of the airway, cuffs are unnecessary and may lead to tracheal stenosis. However, modern high-volume/low-pressure cuffs have become widely accepted for children.

These authors compared leakage, ventilation, and complications with cuffed versus uncuffed endotracheal tubes in a randomized trial of 104 children aged ≤16 years undergoing elective surgery at a single pediatric center in Australia. Initial tube size was 0.5-mm smaller for cuffed than uncuffed tubes. Cuff pressure was set to ≤20 cm H₂O and monitored continuously. Participants were followed for 3 to 5 years for long-term outcomes.

Of children rand…