The Pre-brief
When you have a pediatric patient that needs an emergent airway, you need to be able to quickly find the tube you need!
In the past, uncuffed tubes were used as the standard of care for children younger than 8 years old due to concerns about airway trauma and post-extubation stridor. Currently, however, most ETTs have low-pressure cuffs resulting in a lower risk for airway trauma, airway swelling, or need to use steroids after extubation.. That being said, cuffed endotracheal tubes are recommended in the pediatric population as the initial tube choice. Research shows that ETT cuffs should be inflated to no more than 20-25 cm H2O.
Better protection against aspiration
Ability to ventilate at lower peak pressures
Allows for better monitoring of airway mechanics such as tidal volumes and air pressures
Changing an ETT can be avoided if a smaller tube is initially inserted
Better for severe lung disease
The Debrief
Cuffed endotracheal tubes are recommended in the pediatric population as the initial tube choice.
The size of a cuffed ETT is the (patients age)/4+3.
Always use a length based tape if there are questions or doubts.
A quick estimate for tube depth is (Size of the ETT)x4.Â
