Author(s)

Masayuki Shibasaki¹, Yasuyuki Suzuki^2*, Tetsuro Kagawa³, Yasuhiro Kogure², Keiichiro Mizuno⁴, Nobuaki Shime⁵

¹Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
²Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan.
³Department of Anesthesia, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan.
⁴Department of Anesthesia, Fukuoka Children’s Hospital, Fukuoka, Japan.
⁵Department of Emergency and Critical Care Medicine, Hiroshima University, Hiroshima, Japan.

Background: Surveys of pediatric endotracheal tube (ETT) management previously reported that specialists in pediatric anesthesia and intensive care medicine preferred to use uncuffed ETTs for children younger than 8 to 10 years of age. The aim of this study was to reveal the most recent attitudes and clinical practices of pediatric ETT management in Japan. Methods: The attitudes and clinical practices of pediatric ETT management were investigated using the data sheets of each institution and each patient. The data sheets contained information on patient characteristics and type of hospital, surgical procedures, devices used for intubation, and ETT information including types, size, depth, intracuff pressure (ICP), interval of ICP measurement, laryngeal packing, ETT exchange, airway complications, and reintubations. Results: The response rate of this survey was 66.7%. More than half of children older than 2 years of age were intubated with cuffed ETTs; 83.5% of cuffed ETTs were used with the cuffs inflated, and ICP was measured in 80.7% of cuffed ETTs. More than half of ICP measurements were only taken at the time of intubation. Post-extubation stridor was rarely observed in cuffed (0.4%) or uncuffed ETTs (1.2%). The pediatric ETT management questionnaire revealed age-based size selection, differences in pressure of air leakage between cuffed (15 - 20 cmH₂O) and uncuffed ETTs (20 - 30 cmH₂O) of different sizes, the depthmarking method of insertion length. Continuous measurement of ICP was not common. Conclusion: This study revealed widespread use of cuffed ETTs in children older than 2 years of age, rarely occurrence of post-extubation stridor, inflation of cuffs, and practice of ICP measurement.

Cuffed Endotracheal Tube, Size Selection, Depth Determination, Intracuff Pressure, Infants, Small Children

Shibasaki, M. , Suzuki, Y. , Kagawa, T. , Kogure, Y. , Mizuno, K. and Shime, N. (2019) National Survey of Attitudes and Practices of Endotracheal Tube Management in Infants and Small Children in Japan. Open Journal of Anesthesiology, 9, 9-22. doi: 10.4236/ojanes.2019.92002.