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To the Editor: Cuffed endotracheal tubes (ETT) can cause damage to the mucosa [1]. Pediatric Ultrathin Microcuff ETT may provide better sealing characteristics and is therefore considered safe. There are limited studies of Microcuff ETT use in young infants [2]. The present study was planned to determine the clinical applicability of Microcuff® endotracheal tube in 0–8 mo, full-term infants (weight 3 kg or more), as per the manufacturer’s recommendations (Microcuff PET, HALYARD*) [3]. After exclusion of patients with cardiac defects, recent respiratory tract infections, and airway anomalies, the enrolled infants’ tracheas were intubated, and cuff pressure was maintained below 20 cm of H2O. The number of children requiring a change of ETT, the number of intubation attempts, and perioperative airway complications were noted. All 38 enrolled patients could be successfully intubated, with a first-pass success rate of 65.8%. Thirteen patients (34.2%) required a change of ETT because of inability to achieve optimum ventilatory conditions (mean age: 6.38 mo, weight: 7.6 kg, and height: 66.54 cm). Manufacturer’s recommendations for the selection of Microcuff ETT size are entirely based on age [4]. This study showed a statistically significant relationship of age, weight, and height for appropriate ETT size selection (Supplementary Fig. S1). The sensitivity and specificity of predicting the size of the ETT are 100% and 96%, respectively when weight is used in combination with age of the patient. Future trials can be conducted in a larger population using wider criteria to select an appropriate-sized cuffed ETT that provides optimum ventilatory conditions with minimum complications. A 3.0 size Microcuff paediatric ETT can be safely used in neonate and young infants. However, for optimal ventilation and a high first-pass ETT success rate, weight of the child should also be considered in the infant population.
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References
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Vardhan, H., Sarna, R., Sen, I.M. et al. Evaluation of Size 3.0 Microcuff Endotracheal Tube in Infants Undergoing Major Surgery under General Anesthesia. Indian J Pediatr 90, 204 (2023). https://doi.org/10.1007/s12098-022-04416-5
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DOI: https://doi.org/10.1007/s12098-022-04416-5