Tag Archives: APLS

Cuffed tracheal tubes for children

In a prospective randomised controlled multi-centre trial, cuffed tracheal tubes were compared with uncuffed tubes in 2246 children aged from birth to five years undergoing general anaesthesia. There was no significant difference in post-extubation stridor but the need for tube exchange was 2.1% in the cuffed and 30.8% in the uncuffed groups (P<0.0001).

From the resuscitation point of view, there remain few if any arguments for using an uncuffed tube.

Prospective randomized controlled multi-centre trial of cuffed or uncuffed endotracheal tubes in small children

Br J Anaesth. 2009 Dec;103(6):867-73

Infant CPR – push deeper?

A small study of 6 PICU patients requiring CPR for cardiac arrest due to primary cardiac disease showed that blood pressure as measured by an arterial line increased when the depth of chest compression was increased from one third to one half of the chest wall diameter (using the hand-encircling method). Systolic, mean, and pulse pressures increased significantly whereas diastolic blood pressure (a key determinant of coronary perfusion) did not.

Should the ILCOR guidelines be changed to recommend deeper chest compressions? More data are needed, but the take home message here may be that invasive arterial monitoring is a good guide to the effectiveness of CPR during cardiac arrest resuscitation.

Depth of sternal compression and intra-arterial blood pressure during CPR in
infants following cardiac surgery