Cuffed endotracheal tubes in paediatrics

The basic function of a tracheal tube is to provide a reliable connection between the patient's airway and the anaesthetic circuit (bag or ventilator). Ideally, this connection should allow a leak at 15–20 cmH2O to prevent pressure-related mucosal perfusion, which varies with age. The anatomy of the paediatric airway differs from that of the adult, until it matures between approximately eight and 14 years of age. For this reason, standard teaching has been to avoid placement of cuffed endotracheal tubes (CETTs) in children who are younger than eight years old. Most paediatric anaesthetists continue to safely use uncuffed endotracheal tubes (UETT) on a daily basis, with a belief that they make an adequate seal as they pass through the cricoid ring. The use of CETTs and UETTs has been reviewed and the advantages and safety of CETTs are outlined in this article.